Physio Charlie - acupuncture

Home visits and Acupuncture

noreply@blogspirit.com (PhysioCharlie) — Tue, 24 Nov 2009 18:09:50 +0100

I added this on iCSP today:

Added by: charliecotterill

Posted: 24 November 2009 16:48

One of my patients has asked me if I can treat them with acupuncture in their own home.

Is this part of our registration with the AACP?

Also, will the local council let me have a licence solely to treat people in their own home? I work privately with no clinic base at the moment.

Thanks

Charlie

acupuncture for migrane

noreply@blogspirit.com (PhysioCharlie) — Tue, 05 May 2009 22:03:00 +0200

acupuncture for migrane

From the iCSP website:

Added by: barbaracavan
Posted: 22 April 2009 08:43

I have limited experience in treating patients with headaches with acupuncture. I have reviewed some of the recent literature and it looks quite postive for 'real' and sham acupuncture. Can anyone give me some ideas for point selection including type of headache and any stimulation used.

Thanks

Lynn Pearce:

Hi - this is directed at the other headache query as well really!!

I run a day on headache and acupuncture and the pathology of headache can be complex - the International Headache Society offer at least 10 sub-gorups when trying to classify headaches, and migraine is a group all on it's own.

A few pointers - face pain - where is this?? Likely to be a referral from the opthalmic branch of the trigeminal cranial nerve. Also, this nerve ( and you'll have got this from Dean Watson's course ) can be involved in a structure known as the TCN - the trigemino-cervical nucleus - it's anatomical location puts it in the brainstem and extending down into the cervical spine. Dean feels this structure is effected with mobilising C0 - C 3.

HOWEVER!!! - the neural supply to this region can come from the upper thoracic levels ( notably T 1 - 4, which in turn supplies the superior cervical ganglia and this in turn supplies the C0 - C 3 region.

REAL migraine ( and I say this, as a lot of people say they get migraine when they don;t - they can easily have upper cervical spine driven headache which appears as if it's 'migraine' in the public eye... ) can be treated from a number of points. GB 20 has always been considered THE headache point, but there are a number of ways to effect this area, and ALWAYS assume it's coming from the thoracic / cervical spines until they've been eliminated!!

Bl 10 ( and there are two different locations ) can be useful too, but each patient gets assessed on their own merit and a treatment tailored to them, there is no ' headache recipe'.

If you're looking at the Andrew Vickers study, you'll see that there was a point point suggested, but no 'exact formula'. The common points are GB 21, GB 20, but I would have many other suggestions, based on more clinical info regarding these headaches and how they present.

A word on the other presentation - it is possible that it is Cluster Headache' which is hard to diagnose, more common in men, and harder to treat.!!!

Food for thought for now....

Regards

Lynn P
AACP Tutor

hot flushes and acupuncture

noreply@blogspirit.com (PhysioCharlie) — Tue, 05 May 2009 22:01:23 +0200

hot flushes
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Added by: lisa torrens
Posted: 30 April 2009 10:56

hi,
I have read on an old discussion that there are relevant points for hormonal hot flushes in an article - Acupuncture in Medicine June 2000. I am having trouble finding these articles, could someone help direct me in locating them? Any advice re this topic would be appreciated.
thank you.
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Showing 1 to 4 of 4
Title: hot flushes
Added by: kyriakosantonakos
Posted: 05 May 2009 11:08

Hi
Slightly off topicf but you might be interested also in this:
i have been using acupuncture in the control of hot flushes for post mastectomy patients who are on hormone manipulation therapy as well as men post prostatectomy. The results seem encouraging although more research is needed.
In this category of patients some of the points I find useful often are Ki3, Sp6,9, 3H5, St 36, Du26. I also may use the ASAD points and ear points.
In our unit (an outpatients chemotherapy ward) acupuncture is combined with relaxation visualisation and a graded excs/activity programme, advise also is given to avoid caffeine for the duration of acupuncture treatment (6 sessions).
Attached is the form we use for audit.
Kind regards
Kyriakos

References
Towlerton G, et al: Acupuncture in the control of vasomotor symptoms caused by tamoxifen (letter) PalliatMed 1999;13:445” as cited by Back I. N: Palliative Medicine Handbook, ch. “Sweats and Hot Flushes” page167, third edition 2001,BPM Books.

Filshie-J, Bolton-T, Browne-D, Ashley-S.: Acupuncture and self acupuncture for long-term treatment of vasomotor symptoms in cancer patients - audit and treatment algorithm. Acupunct-Med 2005 Dec; 23(4):171-80, ISSN: 0964-5284.

Nedstrand-Elizabeth, Wyon-Yvonne, Hammar-Mats, Wijma-Klaas: Psychological well-being improves in women with breast cancer after treatment with applied relaxation or electro-acupuncture for vasomotor symptom. In : Journal of psychosomatic obstetrics and gynaecology, {J-Psychosom-Obstet-Gynaecol}, Dec 2006, vol. 27, no. 4, p. 193-9, ISSN: 0167-482X.
acu form Attachment pending approval

Title: thanks for advise
Added by: LT
Posted: 04 May 2009 20:27
thanks for your help, I'll try the points you have suggested and locate the articles to read up on the clinical reasoning.

Title: Hot Flushes , leading to sleep problems
Added by: carolyounger
Posted: 04 May 2009 15:54
I was prescribed HRT by my GP when I was suffering from chronic tiredness caused by hot flushes every night. The symptoms improved immediately but my BP gradually rose to unsafe levels. As soon as I stopped the HRT the Hot Flushes returned with a vengeance. After discussion at an acupuncture update session I began to treat myself using 4 points bilaterally.

They were Heart 6, Triple Heater 6, Spleen 6 and Kidney 6. I needled for about 20 mins and repeated it every 4 days until I had had 4 sessions. By this time my hot flushes had stopped, day and night. After about 5 or 6 months I began to have mild flushes again so I repeated the needling once, with effect.
This treatment has been successful for others, most recently for a work colleague who was beginning to look as sleep-deprived as I used to be! The improvement began after the first session but lasted only about 5 days until a further 3 treatments stopped them altogether.

I hope this is useful for you.
Title: Menopausal symtoms
Added by: AACP Chair
Posted: 03 May 2009 20:33
The points used during menopausal climateric symptoms depend entirely on the hormonal pathology involved.

Please see Acupuncture in Womens health Courses and refer to

Jennie Longbottom paper in Journal of Physiotherapists in Womens' Health 2008

Can acupuncture keep our hormones happy?

New website!!

noreply@blogspirit.com (PhysioCharlie) — Mon, 09 Mar 2009 19:22:00 +0100

I have a new website!!

http://physiocharlie.vpweb.co.uk

Evidence for use of Acupuncture

noreply@blogspirit.com (PhysioCharlie) — Tue, 27 Jan 2009 14:36:37 +0100

I found this discussion on the CSP website:

Added by: barbaracavan
Posted: 22 January 2009 13:58

I am a new band 6 physio working in a physio department which employs a very 'hands off' approach to treatment. We see mostly chronic conditions. I am the only AACP approved physio working there. Other physios in the department practice acupuncture, but do so very rarely. Some physios have considered doing a full 80 hour AACP course but they have put this on hold due to 'lack of evidence' to support the use of acupuncture. Can anyone point me in the direction of some recent sound studies/ guidelines supporting the use of acupuncture? I personally have good results but understandably they want to see sound evidence and studies.

Any information would be appreciated. Thanks

Showing 1 to 10 of 10

Title:	Acupuncture evidence
Added by:	jetturner
Posted:	22 January 2009 14:47

There are several good articals in recient years the most recient that I've seen is by Haake et al 2007. German acupuncture trials (GERAC) for chronic LBP. Arch Intern Med 167 (17):1892-1998.

Nice have reciently publisted their draft guidelines for LBP in which they recomend that acupuncture is a safe, effective treatment for chronic LBP. The full guideline whic are published on the NICE website include the artical referrances that they have used to support their recomendations.

Hope this helps.

Title:	acupuncture
Added by:	nakky
Posted:	22 January 2009 14:49

There is certainly a growing amount of evidence that supports the effectiveness of needling. If you have a look at the journal of Acupuncture in Medicine you will find lots of positive research. It is probably also worth your while to contact the acupuncture association of chartered physiotherapists directly, as they will be aware of the latest research in the field.

Title:	Acupuncture
Added by:	apurvamurthy
Posted:	22 January 2009 15:33

Quiet a few positive research findings in the recent journal of acupuncture in medicine.
Iam sure it will be of help.

Title:	Some evidence exists
Added by:	rhisiart
Posted:	22 January 2009 15:44

Although systematic reviews can sometimes hide useful data, they nevertheless offer the best source of evidence for any treatment approach. Here are some Cochrane systematic review conclusions:

1. Acupuncture for tension-type headache (Klaus L et al 2009). "Acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches."

2. Acupuncture for shoulder pain (Green S et al 2005). "From the little evidence that there is, acupuncture may improve pain and function over the short term."

3. Acupcunture for low back pain (Furlan AD et al 2005). "The data do not allow firm conclusions about the effectiveness of acupuncture for acute low-back pain. For chronic low-back pain, acupuncture is more effective for pain relief and functional improvement than no treatment."

4. Acupuncture for neck pain (Trinh K et al 2006). "There is moderate evidence that those who received acupuncture reported less pain at short term follow-up than those on a waiting list."

Not startling evidence (acupuncture does appear to be better than no treatment in some cases) and many other systematic reviews provide little evidence for the use of acupuncture in areas such as stroke management.

Even where acupuncture presents better than no treatment, the placebo effect is difficult to eliminate entirely.

The lack of robust evidence for acupuncture is often undermined by poor research methods. As better studies come forward, we may be gain a greater understanding of the presence or absence of potential non-placebo clinical benefits.

Title:	evidence for acupuncture
Added by:	michellerogers
Posted:	22 January 2009 16:01

I would also suggest contacting Panos Barlos at Keele university.He appears to have 100's of research papers on the use/efficacy of acupuncture.Good luck

Title:	Acupuncture evidence
Added by:	stucam
Posted:	22 January 2009 16:15

Acupuncture in medicine journal is a good source of information or visit the website www.acupunctureinmedicine.org.uk

The AACP could also point you in the right direction.

I work privately and find I have some very good results with acupuncture but I get to spend a little longer than the usual 20minute nhs appointment. Is it difficult to administer acupuncture in this time period?

Title:	Evidence for use of Acupuncture
Added by:	TJCSmith
Posted:	22 January 2009 19:00

http://www.ncbi.nlm.nih.gov/pubmed/

Hello

A quick search using the link above with give you loads of articles to support the use of acupuncture. There are also plenty of articles that will cause you to question the use of acupuncture but they are also worth reading and considering.

I hope that helps.

Title:	Evidence
Added by:	AACP Chair
Posted:	23 January 2009 17:49

If you are looking for evidence then there is a plethera of it in terms of systematic reviews, pain, inflammation etc. But, whilst you are at it ,and if you have access to the athens, science direct or such databases tell me the evidence for:
electrotherapy
manual therapy
traction
Massage
Mobs?

Be careful you are not singling out acupuncture, which has probably the most robust evidence available, when other modalitities have little or non, other than exercise.

Title:	Acupuncture
Added by:	timpowell
Posted:	26 January 2009 09:29

You are not the first to come across this problem and as other people such as Jennie Longbottom have pointed out - you could argue the evidence for every form of treatment we offer.

Just because a condition is 'chronic' does not necessarily mean it should be treated with advice and exercise only - although I agree that this can make up a big proportion of your treatment plan. However, there is a need to be pragmatic and judge each case on its merits and apply clincal reasoning .

Try flipping the coin round on your colleagues and get them to lit review their hands off approach - I will bet 'core stabilty' is a recurrent theme in the treatments - get them to compare the efficacy of this for back pain.

Title:	Other therapies?
Added by:	rhisiart
Posted:	26 January 2009 12:28

The AACP Chair makes a valid point about not singling out acupuncture for evidence-based scrutiny.

The Randomised Control Trial (RCT) remains the gold standard for testing therapies. However, complex treatments involving multiple variables make RCTs hard to conduct.

This often the case when examining any physiotherapeutic treatment, be it acupuncture, mobilisations, educating patients etc.

This is in part due to the immense difficulty in accurately measuring the effects of the clinician-patient relationship and separating these effects from the actual effects of the passive treatment (e.g. acupuncture or mobs).

I challenge anyone to come up with an ethically sound RCT that can single out any modality (acupuncture, mobs or whatever) that completely excludes the relationship between the physiotherapist and the patient.

Of course, this would be the only way to critically assess the technical ‘cold’ aspect of the passive treatment itself.

Policy for acupuncture in pregnancy related pelvic/ low back pain

noreply@blogspirit.com (PhysioCharlie) — Wed, 22 Oct 2008 17:10:15 +0200

Analysis and interpretation of evidence for the use of acupuncture for pelvic (including low back) pain in pregnancy:

http://www.interactivecsp.org.uk/uploads/documents/Acupuncture%20for%20Pelvic%20pain%20in%20pregancy.doc

Protocol

1. Acupuncture for pelvic pain must not be offered until the foetal gestational age has reached 13 weeks. Gestational age of the foetus is calculated from presumed ovulation date. [The length of uncomplicated gestation is 274 days in primiparas and 269 days in multiparas (Mittendorf et al., 1990).]

2. Patients should have attended either an obstetric advice group or an individual appointment with a physiotherapist before acupuncture is considered.

3. A basic pelvic assessment and appropriate treatment for pelvic pain should be carried out before assessment for acupuncture is undertaken.

4. In obtaining informed consent to acupuncture from the patient the possible side effects, reported in relation to this type of intervention, must be given. These include local pain, haematoma, heat/sweating, ecchymosis, nausea, tiredness and weakness. The physiotherapist should reassure the patient that if they experience any local pain then the needle in question would be removed.

5. The patient must be advised that they should not experience strong stimulation. If they do then they must inform the physiotherapist immediately so that stimulation can be stopped and if necessary the needle(s) involved can be re-sited or removed.

6. Points SP5, KI6, GB34, GB39, GB40, ST36, ST40, ST44, TE5, and GV20 should be palpated for tenderness by the physiotherapist and points selected according to tenderness if possible. No more than 4 needles to be used at the first treatment session, and no more than 8 needles to be used at any time.

7. Superficial or intramuscular insertion, where appropriate, may be used. If intramuscular insertion is used then some attempt at obtaining deQi sensation is permitted but should not be prolonged. Avoid obtaining strong deQi.

8. Needle diameter and length may vary according to patient size and needle site. Smaller diameter needles will produce less stimulation to the nervous system but the patient may need adequate stimulation to produce a clinical improvement in pain relief.

9. Needle retention time should generally be for 25-30 minutes, although a shorter session is appropriate at the first treatment.

10. Gentle stimulation of the needle at intervals through the session is permitted.

11. A balance of points above and below, left and right is to be aimed for.

12. A course of treatment needs to be 2 to 3 times a week for at least a month to maximise effectiveness. This needs to be agreed with the patient and adequate staff resources available to implement such a programme of treatment. In order to maximise effectiveness patients who are 35 weeks or more into their pregnancy should not be considered for acupuncture.

References

Grieve, G (1979) Mobilisation of the spine. Edinburgh, Churchill Livingstone.

Lundeberg T and Stener-Victorin E (2002) Acupuncture handbook of points, Stockholm.

Mittendorf R, Williams MA, Berkey CS, Cotter PF (1990) The length of uncomplicated human gestation. Obstet Gynecol. Jun; 75(6): 929-32. Comment in: Obstet Gynecol. 1990 Oct; 76(4): 732-4.

Smith C, Crowther C, Beilby J (2002) Acupuncture to treat nausea and vomiting in early pregnancy: a randomized trial. Birth: Mar 29(1); 1-9.

Smith C, Crowther C, Beilby J (2002) Pregnancy outcome following women’s participation in a randomized controlled trial of acupuncture to treat nausea and vomiting in early pregnancy. Complement Ther Med: June 10(2); 78-83.

Interventions for Hip OA

noreply@blogspirit.com (PhysioCharlie) — Mon, 08 Sep 2008 15:45:52 +0200

http://www.ptjournal.org/cgi/reprint/ptj.20070042v1

Effectiveness of Nonpharmacological and Nonsurgical Interventions for Hip Osteoarthritis: An Umbrella Review of High-Quality Systematic Reviews, (2007) Moe et al, Volume 87 Number 12 Physical Therapy

An increasing number of systematic reviews are available regarding nonpharmacological and nonsurgical interventions for hip osteoarthritis (OA). The objectives of this article are to identify high-quality systematic reviews on the effect of nonpharmacological and nonsurgical interventions for hip OA and to summarize available high-quality evidence for these treatment approaches.

The authors identified and screened 204 reviews. Two independent reviewers using a previously pilot-tested quality assessment form assessed the full text of 58 reviews. Six reviews were of sufficient high quality and could be included for further analyses. There was moderate-quality evidence that acupuncture and diacerein have no effect on pain and function. There was low-quality evidence that strengthening exercises and avocado/ soybean unsaponifiables reduce pain and that diacerein decreases radiographic OA progression. There was insufficient high-quality evidence regarding nonpharmacological and nonsurgical interventions for hip OA, and further primary studies and reviews are needed.