Results from the “Acupuncture for chronic pain in the Vermont Medicaid population” trial will be presented in the context of events that preceded and followed from the trial. Emphasis will be placed on strategies that may help attendees to participate more effectively in the complex world of healthcare policy decision making. The story begins with the US opioid crisis and brings together a diverse set of stakeholders, including state legislators, local health care and insurance officials, the medical community, the local Licensed Acupuncturist workforce, and a population of underserved patients on public assistance who suffer from chronic pain. The format will provide attendees with a deeper context and insight into the unique challenges, constraints and rewards of working in a pragmatic, policy-oriented and politicized research environment.

The published paper is here: http://journals.sagepub.com/doi/10.1177/2164956118769557

 

Endometriosis is a gynaecological disorder affecting 6-10% of all women in their reproductive age. Previous studies have shown an association between pelvic pain and trauma. We wanted to know if patients with painful endometriosis may benefit from a treatment combining psychotherapy for trauma release with acupuncture and related techniques.
67 patients with severe painful endometriosis were included in the study. Functional magnetic resonance imaging was used to assess brain connectivity of these patients at baseline, after three months of therapy and after six months. The analysis was focused on the hippocampus.
We identified a cortical network comprising the right anterolateral hippocampus – a region modulating the hypothalamic-pituitary-adrenal (HPA) axis – and brain regions involved in somatosensory, viscerosensory and interoceptive processing. Regression analysis showed that reduction in connectivity of this network predicted therapy-induced improvement in patients' anxiety in the treatment group, but not in the control group.

We conclude that patients with endometriosis, who suffer from pelvic pain, can obtain substantial benefit from acupuncture-enhanced psychotherapy. We have identified a putative mechanism underlying this potent combination of therapies and our results emphasize the importance of trauma as a central factor in the aetiology of pelvic pain.

This presentation will introduce the results of a pilot study recently completed at London South Bank University. The study was a double-blind randomised controlled trial that compared warm needle acupuncture to needle acupuncture. On the surface this was a relatively straightforward investigation. However, the protocol is also an example of a component efficacy trial. Ian will also discuss the potential benefits of analysing clinical research in terms of the components of acupuncture rather than the binary conceptualisation of acupuncture versus sham. This approach can be used to design studies to demonstrate that acupuncture has non-psychologically mediated effects; in other words, it is not simply a placebo.  Different conditions are more suitable for investigating specific aspects of acupuncture than others. Ian will set out why osteoarthritis was chosen for this particular trial.

Symposium 2018

Posters 2018

As well as displaying a poster these presenters also share a 30 minutes speaking slot. Each will have about 5 mins plus questions, so it’s a quick fire succession of tasty morsels to tickle your taste buds before lunch. This is the current line-up:

Richard Bertschinger

Qigong and tai-chi interventions: an summary of recent research

Mel Hopper Koppelman

What types of evidence are available? How can they best be used to support acupuncture?

David Mayor

Personality and treatment response to electroacupuncture. A new measure of mood change and further analysis of questionnaire response styles

Helen Walker

Is there an equivalent effect between an acupuncture needle retention time of 5 minutes compared to 20 minutes in patients with osteoarthritis of the knee? A pilot cross-over randomised controlled trial

Over the last 20 years Volker has spent much time trying to find frameworks for understanding East Asian medicines in a manner that does not impose on them our modern needs and our ways of imagining the world, yet allowing for comparison and critique. He believes that such frameworks are essential not merely for historians but also for practitioners seeking to develop their tradition unfettered from the dominance of modern Western concepts. These concepts are not restricted to biomedical science but also include apparent alternatives, such as holism, systems thinking, and the dream of a pure tradition located in the ‘classics' to which we can return.
In his presentation, Volker will argue that in order to accomplish these goals, we might think of medical practice as primarily a problem solving activity. Developing different styles is one way in which East Asian medicines have tried to resolve the problems of medical practice that have confronted them at different historical moments. Understanding these interconnections can help us to develop the potential of East Asian medicines in relation to our own practices and also has important implications for clinical research.

This presentation reports on a study to develop and implement evidence-based clinical practice guidelines for the treatment of frequently diagnosed diseases in the field of traditional Korean medicine. Standard reporting guidance was developed in the form of a checklist and description of items and examples. This included 5 items and 40 sub-items and was designed to improve the reporting of CPGs in traditional medicine, thereby facilitating their interpretation and replication.
Clinical practice guidelines for traditional Korean medicine have been developed for seven disease entities: facial palsy, herniation of the lumbar vertebra, atopic dermatitis, ankle sprain, shoulder-arm pain, obesity and depression. Randomized clinical studies were then conducted to evaluate the applicability of these guidelines, by comparing treatment outcomes from practitioner groups who were given the CPG information in a leaflet against those who were not given this information.

This presentation covers two major projects on pattern identification, for stroke and for blood stasis. The 9-year stroke project ran from 2005 to 2013 and was divided into three 3-year stages. The objective of the first phase was to standardize stroke diagnosis using pattern identification, to create a standard clinical chart with a combination of TKM and Western medicine, and to construct a biobank and find biomarkers associated with patterns of stroke. The objective of the second and third stages was validation and confirmation of the standardised patterns developed in the first phase, using clinical data and candidate biomarkers. Data from 4,921 stroke patients were collected and this presentation will show the process of developing standardized traditional diagnostic methods for pattern identification and their clinical application.
The second part of the talk focuses on the diagnosis of the blood stasis pattern in Chinese Medicine. This is characterised by stagnation, including extravasated blood and sluggish blood circulation or viscous or congested blood, all of which may become pathogenic factors. Blood stasis is associated with chronic and incurable disease, such as pain, infertility, cancer and health conditions caused by stress, which are not curable with modern medicine. A community-based, multi-centre trial was designed as an observational study, with data collected in order to standardise blood stasis diagnosis in Korea. This presentation will show the modern concept of blood stasis by developing a diagnostic tool and diagnostic indices for blood stasis, identify the biological indices and pathological mechanisms related to blood stasis, construct a clinical study base and database for diagnosing and treating blood stasis, and establish traditional Korean medicine diagnoses and treatments for blood stasis disease.

Over the last 20 years, many clinical trials have attempted to assess the benefits of acupuncture on IVF treatment but they have all  differed in study design, protocol, outcome measures and commercial bias. This heterogeneity has precluded any firm conclusion regarding the efficacy or otherwise of acupuncture in this field. To address this heterogeneity, and to try and  provide an evidence based conclusion , it was decided to adopt the Delphi consensus protocol which was reached in 2012 via 15 international acupuncturists with extended experience in treating women with acupuncture during IVF. This protocol was recommended for future research (Smith et al 2012) but so far has not been implemented:  this is the first study to use it.
The  study was a randomised controlled trial which was  conducted over 2 years at the fertility department of the Homerton hospital in London. The primary end point was live birth rate.
The final results show a large difference between the acupuncture group and the control group in favour of acupuncture.  The acupuncture group was found to be superior for both positive pregnancy tests   and live birth rates.
 The results of this study suggest that acupuncture should be offered as a possible method of improving IVF outcome. This study is the first to follow a widely approved consensus protocol hoping to settle disagreement in the literature and resolve previous disparity.

The Acupuncture Trialists Collaboration published a seminal paper on acupuncture for chronic pain in 2012, which already has been cited over 500 times. The chronic pain conditions included back and neck pain, shoulder pain, osteoarthritis and headache and migraine. In this presentation Hugh will provide an update of the results, with the addition of data from 10 more trials published between 2008 and 2015, totalling of 39 trials and over 20,000 patients.

The findings reinforce the message of the original meta-analysis, namely that acupuncture has a moderate effect when compared to non-acupuncture controls (such as usual care or wait-list) and a small effect when compared to sham acupuncture. The main criticism of the study, that the difference between acupuncture and sham is too small to be meaningful, will be addressed by comparing effect sizes across a range of interventions vs. sham or placebo. Also new data will be presented on the trajectory of reported outcomes, estimating that only 15% of the benefit is lost at 12 months after treatment.

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