The standardization of acupuncture treatment for radiation-induced xerostomia: A literature review.

OBJECTIVE: To assess the relative standardization of acupuncture protocols for radiation-induced xerostomia. METHODS: A literature search was carried out up to November 10, 2012 in the databases PubMed/MEDLINE, EMBASE and China National Knowledge Infrastruction with the terms: radiation-induced xerostomia, acupuncture, acupuncture treatment, and acupuncture therapy. Five ancient Chinese classic acupuncture works were also reviewed with the keywords "dry mouth, thirst, dry tongue, dry eyes and dry lips" to search the effective acupuncture points for dry mouth-associated symptoms in ancient China. RESULTS: Twenty-two full-text articles relevant to acupuncture treatment for radiation-induced xerostomia were included and a total of 48 acupuncture points were searched in the 5 ancient Chinese classic acupuncture works, in which the most commonly used points were Chengjiang (CV24), Shuigou (GV 26), Duiduan (GV 27), Jinjin (EX-HN 12), and Yuye (EX-HN 13) on head and neck, Sanjian (LI 3), Shangyang (LI 1), Shaoshang (LU 11), Shaoze (SI 1), Xialian (LI 8) on hand, Fuliu (KI 7), Dazhong (KI 4), Zuqiaoyin (GB 44), Taichong (LR 3), Zhaohai (KI 6) on foot, Burong (ST 19), Zhangmen (LR 13), Tiantu (CV 22), Qimen (LR 14) on abdomen, Feishu (BL 13), Danshu (BL 19), Xiaochaogshu (BL 27), Ganshu (BL 18) on back, Shenmen (TF 4), Shen (CO10, Kidney), Yidan (CO11, Pancreas) and Pi (CO13, Spleen) on ear. CONCLUSION: There were considerable heterogeneities in the current acupuncture treatment protocols for radiation-induced xerostomia. Based on the results of the review and the personal perspectives, the authors provide a recommendation for manual acupuncture protocols in treating radiationinduced xerostomia patients with head and neck cancer.

Current licensure for acupuncture in the United States.

This article reviews current licensure and certification standards for the practice of acupuncture in the United States. It serves as a current reference for the regulation of the practice of acupuncture, the licensing of acupuncturists, and the certification and training of physicians, chiropractors, dentists, podiatrists, and naturopathic physicians to practice acupuncture. Two national accreditation bodies are responsible for certifying acupuncture training and practice. The Accreditation Commission of Acupuncture and Oriental Medicine establishes accreditation criteria and curriculum evaluation of acupuncture training programs. The National Certification of Acupuncture and Oriental Medicine certifies individuals to practice acupuncture in the United States. Although national standards have been established, regulations regarding training and the practice of acupuncture are determined individually by each state, and tend to vary widely. Typical acupuncture training curricula for physicians and chiropractors are discussed, and variations in training requirements by state for acupuncturists and each of the other 5 disciplines is provided.

Clinical research on acupuncture. Part 1. What have reviews of the efficacy and safety of acupuncture told us so far?

UNLABELLED: OVERVIEW AND METHODS: This paper discusses those medical conditions in which clinical trials of acupuncture have been conducted, and where meta-analyses or systematic reviews have been published. It focuses on the general conclusions of these reviews by further examining official reviews conducted in the United States, United Kingdom, Europe, and Canada each of which examined available systematic reviews. While all reviews agree that the methodological rigor of acupuncture clinical trials has generally been poor and that higher quality clinical trials are necessary, this has not completely hampered the interpretation of the results of these clinical trials. In some conditions the evidence of efficacy has clearly reached a sufficient critical mass from enough well-designed studies to draw clear conclusions; for the rest, the evidence is difficult to clearly interpret. This paper also examines conclusions from the same international reviews on the safety and adverse effects of acupuncture. Here, conclusions are more easily drawn and there is good agreement about the safety of acupuncture. RESULTS AND CONCLUSIONS: General international agreement has emerged that acupuncture appears to be effective for postoperative dental pain, postoperative nausea and vomiting, and chemotherapy-related nausea and vomiting. For migraine, low-back pain, and temporomandibular disorders the results are considered positive by some and difficult to interpret by others. For a number of conditions such as fibromyalgia, osteoarthritis of the knee, and tennis elbow the evidence is considered promising, but more and better quality research is needed. For conditions such as chronic pain, neck pain, asthma, and drug addiction the evidence is considered inconclusive and difficult to interpret. For smoking cessation, tinnitus, and weight loss the evidence is usually regarded as negative. Reviews have concluded that while not free from serious adverse events, they are rare and that acupuncture is a relatively safe procedure.

Description and validation of a noninvasive placebo acupuncture procedure.

OBJECTIVE: To evaluate a simulated acupuncture technique for use in randomized controlled trials assessing the efficacy of acupuncture for low-back pain. SETTING: The clinic of an accredited acupuncture college in Seattle, Washington. SUBJECTS: Acupuncture-naïve enrollees of Group Health Cooperative who had visited their primary care provider with a complaint of back pain that persisted for at least 3 months. EXPERIMENTAL DESIGN: In the first experiment, subjects received six insertions of real needles and six pokes with a toothpick in a guidetube in a two-period crossover design. In the second experiment, subjects were randomly assigned to receive either a complete treatment with real acupuncture needles or a simulated treatment using a toothpick in a guidetube. OUTCOMES: In the first experiment, we compared subjects' perceptions about which implement was used for each "insertion" while in the second, we compared the perceptions (e.g., acupuncturist's warmth and caring, the reasonableness of acupuncture as a treatment) and pain relief of those who received an acupuncture treatment using needles to those receiving simulated acupuncture. RESULTS: In the first experiment, the toothpick insertions were perceived as slightly more like real needling than the real needling (mean ratings of 2.8 and 2.1, respectively; p = 0.08). In the second experiment, 52% percent of those receiving the simulated needling versus 65% of those receiving real acupuncture believed they were "definitely" or "probably" receiving real acupuncture (p = 0.33). Perceptions of acupuncture, as measured by a credibility questionnaire, were similar in the two groups. Those receiving real acupuncture were more likely to report immediate pain relief, and this was the factor most predictive of the subject's belief about which treatment they had received (p = 0.02). CONCLUSIONS: The simulated acupuncture procedure evaluated in this study represents a reasonable control treatment for acupuncture-naïve individuals in randomized controlled trials assessing the efficacy of acupuncture for low-back pain.

Practising acupuncture in the developing world.

Historically a GP, Dr Sarah Watkins took up acupuncture relatively late in her career, but has taken it a long way since then. In this article she presents a vivid picture of what it is like to introduce acupuncture to remote rural populations in parts of the developing world. She describes the rapidly growing demand of the local populations following just word-of-mouth spread that a new treatment was available; the different needle length requirements of the impoverished locals compared with the average well-fed westerner; and the simple, safe and effective treatment regimes that she developed and introduced to the local trained nurses, in order to cope with the numbers of patients and to provide continuity of care after her departure. Sarah also comments on the emerging pattern of response that she has observed amongst her patients, and enters into a brief discussion of why this might be so. Early influences on her technique include Felix Mann, Chan Gunn, and a period of study at the Nanjing College of TCM in China. Whilst in the United Kingdom Sarah divides her time between private practice and working as a police surgeon, but is planning return trips to both Bangladesh and Ethiopia, plus fresh pastures in Vietnam and Kerala in south west India.