Delivering Acupuncture Therapy in an Interdisciplinary Global Health Setting in Guatemala: Pilot Study and Lessons Learned.

Objective: Pain, stress, and diabetes mellitus (DM) are common complaints for Guatemalans seeking health care. Because acupuncture therapy (AT) is a low-cost, effective treatment for these concerns, it was offered to Guatemalans during a health care mission as an adjunct to primary care. The purpose of this study was to gather feedback about providing AT in this context and to describe the lessons that were learned. Materials and Methods: A pretest single-arm exploratory study design was used, collecting demographic data and administering a pretest to patients referred for AT. Patients received AT according to presenting symptoms, except patients with DM, who were treated with a previously developed auricular AT protocol. After AT, all patients received adhesive seeds for self-administered auricular acupressure, along with a printed diagram, showing where and how to apply them, and a symptom-tracking form. Results: AT was given to 11 patients (1 had DM; 10 did not). Most were female (9; 82%), older (average 59.27 years; range: 40-81 years), and had little education (average 4 years; range: 0-12 years). Complaints were pain (11; 100%), insomnia (6; 55%), anxiety (4; 36%), depression (7; 64%), and stress (3; 27%). More than 50% had seen health care providers (6; 55%). One person had AT previously and 3 people requested more information about AT before receiving it. Conclusions: Reporting high symptom burdens, most patients were unfamiliar with AT. AT ceased when the licensed acupuncturist contracted COVID. Patients will be followed in 2023 and AT will be given to collect data on feasibility, satisfaction, and possible implementation.

Chinese Herbal Medicines During the Covid-19 Pandemic: A Role for Observational Studies.

Editor's Note: This column continues the JACM commentary series from the Society for Acupuncture Research (SAR). The authors, Claudia Citkovitz, PhD, LAc, from NYU Langone Hospital - Brooklyn and Rosa N. Schnyer, DAOM, LAc, from the University of Texas, are both licensed East Asian Medicine (EAM) clinicians as well as researchers. The dual roles inform this commentary. As clinicians, they respect development over the centuries of strategies toward epidemics by the Chinese and are intrigued by the high use of Chinese herbal medicine to treat COVID-19 in China. As researchers, they are aware of the robust exploration of integrative strategies in China and the dearth of such interest of exploration by most agencies in the West. In their column, Citkovitz and Schnyer highlight what self-respecting clinician researchers are doing to fill the knowledge gap. They provide background on three separate data gathering initiatives that have collaborated to keep their reporting structures comparable in order to "improve clinical practice in real time": one for detailed case reports, a second via a registry, and the third an observational study that provides quantitative and qualitative data regarding clinical reasoning and patient response. At JACM, we look forward to seeing the kinds of reports these initiatives can cast on the widespread patient experience with integrative and EAM COVID-19. -John Weeks, Editor-in-Chief, JACM.

Developing and employing a 'responsive manualization' in the 'Acupuncture Approaches to Decrease Disparities in Outcomes of Pain Treatment' comparative effectiveness study.

OBJECTIVE: The aim of this article is to describe the process used to develop an acupuncture therapy manual for a large effectiveness trial comparing individual care against group care for chronic pain in an underserved population. The design needed to not only ensure research consistency and replicability but also be 'responsive' to real world heterogeneous and evolving presentations in challenging physical settings. BACKGROUND: Chronic pain is prevalent in the United States. While acupuncture is effective for chronic pain, minority, ethnically diverse and lower socioeconomic populations have limited access. Group acupuncture is proposed as a lower cost option to facilitate access in safety net settings, but research on the effectiveness of group versus individual acupuncture is lacking. METHODS: We engaged a modified Delphi process with expert practitioners from diverse backgrounds who were experienced in individual and group practice. All contributions were recorded and collated for second- and third-round consensus discussions that included contributions by the trial's research acupuncturists. RESULTS: A 'responsive manual' flow chart was created with suggested sequencing that included interviews concurrent with palpation, Tui na, Gua sha, acupuncture needling, ear treatment, basic recommendations and options for departure with rationale. The manual was implemented by six research acupuncturists in five primary care settings in the Bronx, New York, with weekly team meetings to discuss manual use. There were no serious adverse events (AE) and few minor AE reported in this trial. CONCLUSION: A 'responsive manual' can be structured and implemented that is not only consistent and replicable but also flexible to accommodate the real-world clinical needs of practitioners and patients in challenging physical settings.

Effects of acupuncture during labor and delivery in a U.S. hospital setting: a case-control pilot study.

OBJECTIVE: The objective of this study was to assess clinical effects and logistical feasibility of acupuncture given during labor and delivery in a U.S. hospital setting. DESIGN: A case-control pilot study was conducted with 45 parturients receiving acupuncture during labor and delivery alongside standard care. Primary outcome endpoints were incidence of cesarean section, amount of parenteral opioids used, use of epidural anesthesia, and duration of labor. Secondary endpoints included patient satisfaction and nursing staff acceptance as assessed by postpartum questionnaire, maximum flow rate of oxytocin, incidence of instrumental delivery, Apgar score, and incidence of adverse event. RESULTS: Forty-five (45) patients receiving acupuncture were compared to 127 historical controls matched for maternal age, gestational age, parity, and use of oxytocin (augmentation and induction were matched separately). Acupuncture patients underwent significantly fewer cesarean sections (7% versus 20%, p = 0.004). No significant differences were noted in other clinical endpoints. Seventy-eight percent (78%) of nurses reported a subjective perception of improvement in patients' comfort with acupuncture, while 83% reported that the acupuncturists' presence never interfered with their work. Eighty-seven percent (87%) of patients reported that acupuncture had helped them. CONCLUSIONS: Acupuncture during labor and delivery is well tolerated by patients and medical staff. It should be further evaluated for its promise in potentially reducing the incidence of cesarean section.

Towards a model for planning clinical research in Oriental medicine.

BACKGROUND: Oriental medicine (OM) is widely practiced internationally and embraces many schools of thought. Western medical research is currently struggling to understand OM in purely biomedical terms, with limited success. OBJECTIVE: We propose a research model for applying Western research methodologies to OM in a way that respects its theory and modes of clinical application. This would facilitate systematic investigations of OM's specific assumptions and make explicit the way OM studies could build on each other. METHODS: To develop this model, the authors extracted key assumptions of Western research methodology germane to clinical research, put them in a developmentally logical sequence, and related them to the diagnostic and clinical processes of OM. RESULTS: The model categorizes studies into seven levels. Foundation studies (level one) establish the conceptual basis for OM research by establishing the internal validity of its basic "truth statements." Measurement studies (level two) determine how OM identifies and measures diagnostic indicators, treatment outcomes, and other basic aspects of health. Group studies (level three) describe populations in ways meaningful to their health. Pattern/diagnosis studies (level four) identify and define OM patterns of disharmony. Treatment technique studies (level five) describe particular techniques or principles of treatment, their indications, and rationale. Treatment effectiveness studies (level six) evaluate techniques of treatment, often by comparing the results of one technique with those of another in similar patients. Systematic reviews (level seven) draw together studies on the same topic to see if conclusions are thereby strengthened. CONCLUSION: The levels can be used to establish relationships between already published studies, determine if sufficient background research has been done to enable a study idea to be carried out, and generate ideas for future studies.