What makes one respond to acupuncture for insomnia? Perspectives of cancer survivors.

OBJECTIVE: Like any therapy, acupuncture is effective for some patients, while not helpful for others. Understanding from a patients' perspective what makes one respond or not to acupuncture can help guide further intervention development. This study aimed to identify factors that influence the perception of acupuncture's therapeutic effect among cancer survivors with insomnia. METHOD: We conducted post-treatment semi-structured interviews with cancer survivors who were randomized to the acupuncture group in a clinical trial for the treatment of insomnia. Survivors were categorized into Responders and Non-Responders to acupuncture treatment based on the change in the Insomnia Severity Index with a reduction of eight points or greater as the cut-off for the response. An integrated approach to data analysis was utilized by merging an a priori set of codes derived from the key ideas and a set of codes that emerged from the data through a grounded theory approach. Codes were examined for themes and patterns. RESULTS: Among 28 cancer survivors interviewed, 18 (64%) were classified as Responders. Participants perceived the ability to respond to acupuncture as dependent on treatment that effectively: (1) alleviated co-morbidities contributing to insomnia, (2) supported sleep hygiene practices, and (3) provided a durable therapeutic effect. Acupuncture treatment that did not address one of these themes often detracted from positive treatment outcomes and diminished perceived benefit from acupuncture. SIGNIFICANCE OF RESULTS: We identified patient-perceived contributors to response to acupuncture, such as co-morbid medical conditions, adequate support for sleep hygiene practices, and temporary therapeutic relief. Addressing these factors may improve the overall effectiveness of acupuncture for insomnia.

Understanding the Use of Acupuncture for Insomnia Among Cancer Survivors: A Qualitative Study.

OBJECTIVE: To understand cancer survivors' perceptions regarding the use of acupuncture for the treatment of cancer-related insomnia. DESIGN: Semistructured interviews with cancer survivors participating in a randomized controlled trial comparing the effectiveness of Cognitive Behavioral Therapy for Insomnia (CBT-I) and acupuncture for the treatment of insomnia. Interviews were conducted before randomization into either treatment option, and structured to elicit participants' experiences with insomnia as well as their beliefs and understanding surrounding acupuncture for the treatment of insomnia. An integrated approach was used for data analysis. SUBJECTS: Sixty-three cancer survivors with DSM-V diagnosed insomnia. RESULTS: Participants shared a broad lack of understanding regarding acupuncture for the treatment of insomnia. Specifically, individuals in this study expressed confusion surrounding what symptoms or medical conditions acupuncture could be used to treat, how acupuncture works, and how long the effects of acupuncture last. CONCLUSIONS: This study identified three specific gaps in knowledge, including treatment target, mechanism, and durability, surrounding the use of acupuncture for insomnia in cancer survivors. Addressing these gaps by providing appropriate and timely education surrounding the use of acupuncture to treat insomnia is essential to increase the evidence-informed utilization of acupuncture and to better meet patients' needs among cancer survivors.

Double-blind acupuncture needles: a multi-needle, multi-session randomized feasibility study.

BACKGROUND: Efficacy of acupuncture is difficult to demonstrate without a feasible double-blind milieu. Double-blind acupuncture needles have been validated in single session protocols with one or two needles but not been tested in a protocol requiring many needles and repeated sessions. METHODS: We determined the feasibility of a 13-needle, 10-session study protocol. Feasibility focused on (1) enrolling and retaining participants; (2) two acupuncturists accurately implementing a double-blind, multi-needle, multi-session protocol; (3) participants completing measures; and (4) protocol acceptability to participants. In this double-blind randomized controlled pilot study, participants were randomized 1:1 to a penetrating needle group or a skin-touch placebo control group. RESULTS: Six women with vulvodynia (mean age 31.5 ± 8 years; five white, non-Latina, one black/African American) met the eligibility requirements, consented to participation, and were enrolled. All six participants (100%) completed the 10-session study protocol in 5 weeks without missing any treatment sessions. Per observed checklist documented technique, two acupuncturists flawlessly administered the 13-needle, 10-session acupuncture protocol; no needles malfunctioned. Six participants attended all sessions and completed 99% of measurement items. One participant did not like acupuncture (60% acceptability score) and five liked acupuncture (100% acceptability scores); the mean acceptability score was 93.3%. CONCLUSION: Study feasibility was supported. This protocol can be used in a double-blind efficacy trial of acupuncture for vulvodynia. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02704234. Registered 30 November 2015.

The effect of acupuncture on working memory and anxiety.

OBJECTIVE: The purpose of this study was to investigate whether acupuncture can improve memory and reduce anxiety. DESIGN, SETTING AND SUBJECTS: A two-group, randomized, single-blind study involving 90 undergraduate university students was conducted from January to December of 2011. INTERVENTIONS: Subjects completed the State-Trait Anxiety Inventory (STAI) form Y-1 (State Anxiety, SA) and Y-2 (Trait Anxiety, TA). Then, each subject lay on a treatment table for 20 minutes. The acupuncture group had needles inserted into select acupoints; control subjects did not. Subjects then completed the STAI form Y-1 again, after which they completed the Automated Operation Span Task (AOSPAN) - a computerized test of working memory. MAIN OUTCOME MEASURES: Performance on the AOSPAN and the STAI scores were the main measures of the outcomes. RESULTS: The acupuncture group scored 9.5% higher than the control group on the AOSPAN Total Correct Score (65.39 vs. 59.9, p=0.0134), and committed 36% fewer math errors (2.68 vs. 4.22, p=0.0153). Acupuncture subjects also reported lower SA after intervention than control subjects (26.14 vs. 29.63, p=0.0146).