Acupuncture treatment for idiopathic trigeminal neuralgia: A longitudinal case-control double blinded study.

OBJECTIVE: To evaluate the treatment effect of acupuncture on patients with idiopathic trigeminal neuralgia (ITN) by case-control longitudinal blinded study. METHODS: Sixty ITN patients and 30 healthy subjects were included. The ITN patients were randomly assigned to acupuncture group (15 cases), sham-acupuncture group (15 cases) and carbamazepine group (30 cases), respectively. Clinical orofacial evaluation (including pain intensity and medication doses), research diagnostic criteria for temporomandibular disorders (RDC/TMD) and Helkimo indexes (for functional evaluation of the masticatory system), and quantitative sensory testing for sensory thresholds (gustative, olfactory, cold, warm, touch, vibration and superficial and deep pain) were evaluated before treatment, immediately after treatment, and 6 months after treatment. RESULTS: The mean pain intensity by the Visual Analogue Scale only decreased in the acupuncture group at the last evaluation (P=0.012). Patients in the sham-acupuncture group had an increase in carbamazepine doses according to the prescriptions (P<0.01). There was a reduction in secondary myofascial pain and mandibular limitations at the acupuncture and sham-acupuncture groups, however only the acupuncture group kept the changes after 6 months (P<0.01, P=0.023). There was a decrease in mechanical thresholds in the acupuncture group (tactile, P<0.01; vibration, P=0.027) and an increase in deep pain thresholds in both acupuncture and sham-acupuncture groups (P=0.013). CONCLUSIONS: Acupuncture can be an option in the treatment of ITN due to its analgesic effect in both ITN and secondary myofascial pain associated with it.

A randomized, controlled, crossover study in patients with mild and moderate asthma undergoing treatment with traditional Chinese acupuncture.

OBJECTIVES: This study sought to verify the effects of acupuncture as an adjuvant treatment for the control of asthma. METHODS: This was a randomized, controlled, crossover trial conducted at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A total of 74 patients with mild/moderate, persistent asthma were randomized into two therapeutic groups: Group A - 31 patients underwent 10 real weekly acupuncture sessions, followed by a 3-week washout period and 10 sham weekly acupuncture sessions; and Group B - 43 patients underwent 10 sham weekly acupuncture sessions, followed by a 3-week washout period and 10 real weekly acupuncture sessions. Patients used short- and long-acting ß-2 agonists and inhaled corticosteroids when necessary. Prior to treatment and after each period of 10 treatment sessions, the patients were evaluated for spirometry, induced sputum cell count, exhaled nitric oxide (NO) and with the Short Form 36 (SF-36) and Questionnaire on Quality of Life-Asthma (QQLA) questionnaires. Daily peak flow and symptom diaries were registered. The level of significance adopted was 5% (α=0.05). RESULTS: In Group B, after real acupuncture, there was a decrease in eosinophils (p=0.035) and neutrophils (p=0.047), an increase in macrophages (p=0.001) and an improvement in peak flow (p=0.01). After sham acupuncture treatment, patients experienced less coughing (p=0.037), wheezing (p=0.013) and dyspnea (p=0.014); similarly, after real acupuncture, patients reported less coughing (p=0.040), wheezing (p=0.012), dyspnea (p<0.001) and nocturnal awakening episodes (p=0.009). In Group A, there was less use of rescue medication (p=0.043). After the sham procedure, patients in Group A experienced less coughing (p=0.007), wheezing (p=0.037), dyspnea (p<0.001) and use of rescue medication (p<0.001) and after real acupuncture, these patients showed improvements in functional capacity (p=0.004), physical aspects (p=0.002), general health status (p<0.001) and vitality (p=0.019). Sham acupuncture also led to significant differences in symptoms, but these were not different from those seen with real acupuncture. Spirometry and exhaled NO levels did not show a difference between sham and real acupuncture treatment. In addition, no significant difference was demonstrated between treatments regarding the quality of life evaluation. CONCLUSION: Real and sham acupuncture have different effects and outcomes on asthma control. The crossover approach was not effective in this study because both interventions led to improvement of asthma symptoms, quality of life and inflammatory cell counts. Thus, sham acupuncture cannot serve as a placebo in trials with acupuncture as the main intervention for asthma.

A randomized, controlled, crossover study in patients with mild and moderate asthma undergoing treatment with traditional Chinese acupuncture

OBJECTIVES:This study sought to verify the effects of acupuncture as an adjuvant treatment for the control of asthma.METHODS:This was a randomized, controlled, crossover trial conducted at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A total of 74 patients with mild/moderate, persistent asthma were randomized into two therapeutic groups: Group A - 31 patients underwent 10 real weekly acupuncture sessions, followed by a 3-week washout period and 10 sham weekly acupuncture sessions; and Group B - 43 patients underwent 10 sham weekly acupuncture sessions, followed by a 3-week washout period and 10 real weekly acupuncture sessions. Patients used short- and long-acting β-2 agonists and inhaled corticosteroids when necessary. Prior to treatment and after each period of 10 treatment sessions, the patients were evaluated for spirometry, induced sputum cell count, exhaled nitric oxide (NO) and with the Short Form 36 (SF-36) and Questionnaire on Quality of Life-Asthma (QQLA) questionnaires. Daily peak flow and symptom diaries were registered. The level of significance adopted was 5% (α=0.05).RESULTS:In Group B, after real acupuncture, there was a decrease in eosinophils (p=0.035) and neutrophils (p=0.047), an increase in macrophages (p=0.001) and an improvement in peak flow (p=0.01). After sham acupuncture treatment, patients experienced less coughing (p=0.037), wheezing (p=0.013) and dyspnea (p=0.014); similarly, after real acupuncture, patients reported less coughing (p=0.040), wheezing (p=0.012), dyspnea (p<0.001) and nocturnal awakening episodes (p=0.009). In Group A, there was less use of rescue medication (p=0.043). After the sham procedure, patients in Group A experienced less coughing (p=0.007), wheezing (p=0.037), dyspnea (p<0.001) and use of rescue medication (p<0.001) and after real acupuncture, these patients showed improvements in functional capacity (p=0.004), physical aspects (p=0.002), general health status (p<0.001) and vitality (p=0.019). Sham acupuncture also led to significant differences in symptoms, but these were not different from those seen with real acupuncture. Spirometry and exhaled NO levels did not show a difference between sham and real acupuncture treatment. In addition, no significant difference was demonstrated between treatments regarding the quality of life evaluation.CONCLUSION:Real and sham acupuncture have different effects and outcomes on asthma control. The crossover approach was not effective in this study because both interventions led to improvement of asthma symptoms, quality of life and inflammatory cell counts. Thus, sham acupuncture cannot serve as a placebo in trials with acupuncture as the main intervention for asthma.

Effects of structural integration Rolfing® method and acupuncture on fibromyalgia / Efeitos do método Rolfing® de integração estrutural e da acupuntura na fibromialgia

ABSTRACT BACKGROUND AND OBJECTIVES: Considering that a single approach does not encompass all symptoms of fibromyalgia syndrome and so indicated therapy is multidisciplinary, this study aimed at observing the efficacy of Structural Integration Rolfing method, of acupuncture, and of the combination of both techniques for relieving pain, anxiety and depression and for improving quality of life of fibromyalgia patients. METHODS: Participated in the study sixty patients of the Multidisciplinary Pain Center, Neurological Clinic, Clinicas Hospital, School of Medicine, University of São Paulo, who were randomly distributed in three groups: group A – submitted to 10 acupuncture sessions; group B – 10 Rolfing sessions; and group C – 10 Rolfing and 10 acupuncture sessions. All patients have maintained their routine outpatient treatment and were evaluated according to Fibromyalgia Impact Questionnaire, Pain Numeric Verbal Scale and Beck Anxiety and Depression Inventories, applied during initial interview, after the last session and three months after treatment completion. RESULTS: There has been statistically significant improvement in the three groups with regard to all evaluated items. CONCLUSION: Both techniques, individually or in association, were beneficial during the three months of follow up. .

RESUMO JUSTIFICATIVA E OBJETIVOS: Considerando-se que um único tratamento não abrange todos os sintomas apresentados no quadro da síndrome fibromiálgica e que, portanto, a conduta terapêutica indicada é multidisciplinar, o objetivo deste estudo foi verificar a eficácia do método Rolfing de Integração Estrutural, da acupuntura e da combinação das duas técnicas no alívio da dor, nos estados de ansiedade e depressão e na melhora da qualidade de vida dos fibromiálgicos. MÉTODOS: Sessenta pacientes do Centro Multidisciplinar de Dor da Clínica Neurológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo foram randomizados em três grupos: grupo A: submetidos a 10 sessões de acupuntura, grupo B 10 sessões de Rolfing e grupo C 10 sessões de Rolfing e 10 de acupuntura. Todos mantiveram o tratamento ambulatorial de rotina e foram avaliados de acordo com o Questionário de Impacto da Fibromialgia, a Escala Verbal Numérica de Dor e os Inventários de Ansiedade e de Depressão Beck, aplicados durante a entrevista inicial, após a última sessão e três meses após o término do tratamento. RESULTADOS: Houve melhora estatisticamente significativa nos pacientes dos três grupos em relação a todos os quesitos avaliados. CONCLUSÃO: As duas técnicas foram benéficas tanto individual quanto associadamente, durante os três meses de acompanhamento. .

Efeitos da acupuntura sobre os pacientes com asma leve e moderada persistentes: um estudo randomizado, controlado e cruzado / Effects of acupuncture on patients with mild to moderate persistent asthma: a randomized, controlled, crossover

Introdução: Este estudo foi realizado com o intuito de avaliar efeitos da acupuntura sobre os pacientes com asma leve e moderada persistentes com o uso de beta-2 agonista ou corticoide inalatório. Métodos e casuística: Trata-se de um estudo prospectivo, duplo-cego, randomizado e cruzado com dois braços. Os 74 pacientes com diagnóstico de asma leve/moderada, de acordo com a classificação de GINA 2002/2003, foram divididos em dois grupos, sendo 31 do Grupo I, e 43 do Grupo II inicialmente. Foram realizadas consultas médicas e exames que incluíram espirometria, citologia de escarro induzido, NO expirado, preenchimento de escala de sintoma, questionários de qualidade de vida de asma e de SF 36, e realização de peak-flow, dependendo da Fase do protocolo. A Fase I constituiu-se dos exames pré-intervenção. Na Fase II, foram realizadas 10 sessões de Acupuntura Real no Grupo I e 10 sessões de Acupuntura Sham no Grupo II, na Fase III, houve 4 semana de washout, na Fase IV, houve a troca de técnicas de acupuntura, sendo uma sessão por semana e, na Fase V, realização dos exames. Resultados: Não há diferença nos critérios de avaliação no pré-tratamento entre dois grupos, com exceção de maior celularidade inflamatória no Grupo II. No entanto, houve uma redução significativa de eosinófilos (p = 0,035) e neutrófilos (p = 0,047), e aumento de macrófagos (p = 0,001), melhora da medida de volume do peak-flow (p = 0,01) na fase IV do Grupo II. No Grupo I, na avaliação de escala de sintomas diária, havia menor uso de medicação de resgate (p = 0,043) na Fase II, e, depois de receber a Acupuntura Sham na Fase IV, havia menos tosse (p = 0,007), menos chiado (p = 0,037), menos dispneia (p < 0,001) e menor uso de medicação de resgate (p < 0,001). No Grupo II, após receber o tratamento com a Acupuntura Sham na Fase II, houve diminuição de tosse (p = 0,037), de chiado (p = 0,013) e de dispneia (p = 0,014), e, na...

Introduction: This survey has been conducted in order to evaluate the effects of acupuncture in patients with persistent mild and moderate asthma (according to GINA criteria 2003), using beta agonist and/or inhaled glucocorticoid. Methods and patients: This is a prospective, double blinded, randomized and cross-over study with two branches: 74 patients diagnosed with mild and moderate asthma were divided into two groups: Group I with 31, initiating with real acupuncture and Group II, starting with sham acupuncture. Medical interview and laboratory tests including spirometry, induced sputum citology, exhaled NO measurement, quality of life questionnaire (SF-36 and QQL), besides, daily symptom scores and measurement of peak-flow were performed, in the beginning of the study, and in the end of each phase of treatment. Phase I: laboratory tests and other qualitative measurements. There were 10 real acupuncture weekly sessions to Group I and 10 sham acupuncture sessions to Group II in Phase II. On the other hand, in the Phase IV, there was an exchange between Group I and Group II, which was receiving real acupuncture started to receive sham, and vice-versa, the number of sessions remained the same (10 weekly sessions). Phase III, during the interval between Phase II and Phase IV, there was an interval of 4 weeks of washout. Phase V: laboratory tests and other qualitative measurements. Results: There was no difference beween both the groups in all criteria of evaluation pré treatment, with only na exception: in the Group II there was large inflammatory cell counts. However, there was a significant reduction in eosinophils (p = 0.035) and neutrophils (p = 0.047), and increase of macrophages (p = 0.001), improved peak-flow measurement in the morning (p = 0.01) in Group II (started with sham) in Phase IV. In Daily Symptons Score, there was a significant reduction in use of rescue medication (p = 0.043) in Group I (real acupuncture) in Phase II and after received...

Acupuntura em adolescentes com fibromialgia juvenil / Acupuncture in adolescents with juvenile fibromyalgia / Acupuntura en adolescentes con fibromialgia juvenil

Descrever a utilização da acupuntura em adolescentes com fibromialgia juvenil. MÉTODOS: Estudo retrospectivo realizado em pacientes com fibromialgia juvenil (critérios do Colégio Americano de Reumatologia) submetidos a, pelo menos, 11 sessões semanais de acupuntura. As avaliações antes e após acupuntura incluíram dados demográficos, características da dor musculoesquelética, número de pontos dolorosos (NPD), escala visual analógica (EVA) de dor, algiometria e índice miálgico (IM). Durante o estudo, os pacientes puderam usar analgésicos, amitriptilina e foram orientados a praticar atividade física aeróbica. Os resultados antes e após acupuntura foram comparados pelo teste não paramétrico de Wilcoxon. RESULTADOS: Dos 38 pacientes com fibromialgia juvenil acompanhados em oito anos consecutivos, 13 tinham todas as informações nos prontuários e nas fichas de acupuntura e foram avaliados. Destes 13, sete obtiveram melhora nos três parâmetros analisados (número de pontos dolorosos, EVA de dor e IM). As medianas do número de pontos dolorosos e da EVA de dor foram significativamente maiores antes do tratamento quando comparados ao final do tratamento com as sessões de acupuntura [14 (11-18) versus 10 (0-15), p=0,005; 6 (2-10) versus 3 (0-10), p=0,045; respectivamente]. Em contraste, a mediana do IM foi significativamente menor antes do tratamento [3,4 (2,49-4,39) versus 4,2 (2,71-5,99), p=0,02]. Nenhum dos pacientes com fibromialgia juvenil apresentou eventos adversos associados à acupuntura. CONCLUSÕES: Acupuntura é uma modalidade de Medicina Tradicional Chinesa que pode ser utilizada nos pacientes pediátricos com fibromialgia. Futuros estudos controlados serão necessários.

To describe the use of acupuncture in the treatment of adolescents with juvenile fibromyalgia. METHODS: Retrospective study of patients with juvenile fibromyalgia (American College of Rheumatology criteria) submitted at least to 11 weekly sections of acupuncture. The evaluations before and after acupuncture included: demographic data, musculoskeletal pain findings, pain visual analog scale (VAS), algometry, and myalgic index (MI). These patients could be treated with analgesics, amitriptyline and aerobic physical activity. The results before and after acupuncture were compared by non-parametric Wilcoxon test. RESULTS: 38 patients had juvenile fibromyalgia in eight consecutive years, 13 had all information in their medical and acupuncture records. Seven of the 13 patients improved in three parameters (number of tender points, pain VAS and MI). The median number of tender points and VAS was significantly higher before than after treatment with acupuncture sections [14 (11-18) vs. 10 (0-15), p=0.005; 6 (2-10) vs. 3 (0-10), p=0.045; respectively]. In contrast, the median MI was significantly lower before treatment [3.4 (2.49-4.39) vs. 4.2 (2.71-5.99), p=0.02]. None of the patients with juvenile fibromyalgia had adverse events associated with acupuncture. CONCLUSIONS: Acupuncture is a traditional chinese medicine modality that can be used in pediatric patients with fibromyalgia. Future controlled studies are necessary.

Describir el uso de acupuntura en adolescentes con fibromialgia juvenil. MÉTODOS: Estudio retrospectivo realizado en pacientes con fibromialgia juvenil (criterios del Colegio Americano de Reumatología) sometidos a al menos 11 sesiones semanales de acupuntura. Las evaluaciones antes y después de la acupuntura incluyeron datos demográficos, características del dolor musculoesquelético, número de puntos dolorosos (NPD), escala visual analógica (EVA) de dolor, algiometría e índice de mialgia (IM). Durante el estudio, los pacientes pudieron usar analgésicos, amitriptilina, y fueron orientados a practicar actividad física aeróbica. Los resultados antes y después de la acupuntura fueron comparados por la prueba no paramétrica de Wilcoxon. RESULTADOS: De los 38 pacientes con fibromialgia juvenil acompañados en ocho años consecutivos, 13 tenían todas las informaciones en los prontuarios y en las fichas de acupuntura y fueron evaluados. De estos 13, siete obtuvieron mejora en los tres parámetros analizados (número de puntos dolorosos, EVA de dolor e IM). Las medianas del número de puntos dolorosos y del EVA de dolor fueron significativamente mayores antes del tratamiento cuando comparados al final del tratamiento con las sesiones de acupuntura [14 (11-18) vs. 10 (0-15), p=0,005; 6 (2-10) vs. 3 (0-10), p=0,045; respectivamente]. Por otra parte, la mediana del IM fue significativamente menor antes del tratamiento [3,4 (2,49-4,39) vs. 4,2 (2,71-5,99), p=0,02]. Ninguno de los pacientes con fibromialgia juvenil presentó eventos adversos asociados a la acupuntura. CONCLUSIONES: Acupuntura es una modalidad de la Medicina Tradicional China que puede ser utilizada en los pacientes pediátricos con fibromialgia. Futuros estudios controlados serán necesarios.

The teaching of acupuncture in the University of São Paulo School of Medicine, Brazil.

OBJECTIVE: Since being introduced as an elective discipline (non-obligatory) in the second semester of 2002, acupuncture has been taught in the University of São Paulo School of Medicine. We conducted this study to verify interest and acceptance among under graduate medical students and to discern a positive influence contributing to improving their skills. METHODS: The study was conducted from 2002 to 2007 using descriptive statistical methods. RESULTS: The average number of students who concluded the discipline is 24.9 students per semester with an average number of medical students per semester of 87.5 (28% of all medical students in the 7th and 8th semesters). After a semester of basic training in acupuncture, only eight students per group are promoted (after selection) to the Medical Academic League of Acupuncture which lasts for two years. Every semester, all eight vacancies are filled. Among the students who concluded the course, 98% described course quality as good or very good, 85% considered themselves at least partially able to use acupuncture and 79% stated that the course influenced them in their medical education. CONCLUSION: There is a genuine interest to learn acupuncture, almost 30% of all students volunteer for a brief training in acupuncture while some of them choose additional training of two years due to the importance of acupuncture as part of professional skills. Results indicate that acupuncture should be included as an elective discipline for medical students.

The teaching of acupuncture in the University of São Paulo School of Medicine, Brazil / O ensino da acupuntura na Faculdade de Medicina da Universidade de São Paulo, Brasil

OBJECTIVE: Since being introduced as an elective discipline (non-obligatory) in the second semester of 2002, acupuncture has been taught in the University of São Paulo School of Medicine. We conducted this study to verify interest and acceptance among under graduate medical students and to discern a positive influence contributing to improveing their skills. METHODS: The study was conducted from 2002 to 2007 using descriptive statistical methods. RESULTS: The average number of students who concluded the discipline is 24.9 students per semester with an average number of medical students per semester of 87.5 (28 percent of all medical students in the 7th and 8th semesters). After a semester of basic training in acupuncture, only eight students per group are promoted (after selection) to the Medical Academic League of Acupuncture which lasts for two years. Every semester, all eight vacancies are filled. Among the students who concluded the course, 98 percent described course quality as good or very good, 85 percent considered themselves at least partially able to use acupuncture and 79 percent stated that the course influenced them in their medical education. CONCLUSION: There is a genuine interest to learn acupuncture, almost 30 percent of all students volunteer for a brief training in acupuncture while some of them choose additional training of two years indue to the importance of acupuncture as part of professional skills. Results indicate that acupuncture should be included as an elective discipline for medical students.

OBJETIVO: Após ter sido introduzida como disciplina eletiva (não obrigatória) no segundo semestre de 2002, a acupuntura tem sido ensinada na Faculdade de Medicina da Universidade de São Paulo (FMUSP) desde então. Esse estudo foi realizado com o intuito de verificar o interesse e a aceitação da acupuntura entre os estudantes de medicina da FMUSP e se, de alguma forma, ela poderia influenciá-los positivamente, contribuindo para melhorar as suas competências. MÉTODOS: O estudo foi conduzido durante o período de 2002 a 2007, utilizando-se métodos de estatística descritiva. RESULTADOS: A média de todos os estudantes que concluíram a disciplina foi de 24,9 alunos por semestre, sendo que a média de estudantes de medicina por semestre é de 87,5 (28 por cento de todos os estudantes de medicina nos 7º e 8º semestres). Após o primeiro semestre de formação básica em acupuntura, apenas oito alunos por grupo são promovidos (após seleção) para a Liga Médica Acadêmica de Acupuntura, que tem a duração de dois anos. Em todos os semestres, as oito vagas são preenchidas. Entre os estudantes que concluíram o curso, 98 por cento consideraram-no de boa ou muito boa qualidade, 85 por cento consideravam-se parcialmente capazes para empregar a acupuntura e 79 por cento consideraram que o curso contribuiu para a sua educação médica. CONCLUSÃO: Existe um real interesse para a aprendizagem da acupuntura, pois em torno de 30 por cento de todos os alunos quiseram passar por um breve treinamento em acupuntura, alguns deles optando por uma formação de dois anos em reconhecimento à importância da acupuntura como parte da capacitação profissional. Os resultados sugerem que a acupuntura deve ser incluída como uma disciplina eletiva para alunos de medicina.

Acupuntura no controle das dores musculares / Acupuncture in the management of masticatory muscle pain in temporomandibular disorders. Review and case report

Acupuntura é utilizada com sucesso no tratamento de diversas condições álgicas. O National Institutes of Health (NIH), em seu consenso divulgado em novembro de1997, atesta que em situações de dor muscular, a acupuntura pode ser considerada terapia adjunta eficaz ou alternativa terapêutica aceitável. No vasto universo das condições álgicas orofaciais, destacam-se as Disfunções Temporomandibulares (DTM). A DTM inclui uma variedade de anormalidades musculoesqueléticas que incluem a articulação temporomandibular, os músculos mastigatórios ou ambos, sendo que a dor muscular mastigatória é sua mais freqüente manifestação clínica, muitas vezes manifestada como cefaléia secundária. O objetivo deste estudo foi de revisar a literatura atual sobre a eficácia da acupuntura no controle da dor muscular na DTM e relatar um caso clínico