THE WAY FORWARD Integration of Acupuncture into Mainstream Medicine Jo Graham & Kate Duke New...

THE WAY FORWARDTHE WAY FORWARD

Integration of Acupuncture into Mainstream Integration of Acupuncture into Mainstream MedicineMedicine

Jo Graham & Kate DukeJo Graham & Kate Duke

New Zealand School of Acupuncture & Traditional Chinese MedicineNew Zealand School of Acupuncture & Traditional Chinese Medicine

What is acupuncture and how does What is acupuncture and how does it work?it work?

EASTERNEASTERN ““Qi”Qi”

WESTERNWESTERN Release of opioid & Release of opioid &

other peptidesother peptides Activates Activates

hypothalamus & hypothalamus & pituitary glandpituitary gland

Alters immune Alters immune functionsfunctions


Why Integration?Why Integration?

Increase in popularityIncrease in popularity AccessibilityAccessibility Safe and fewer side effects or other negative Safe and fewer side effects or other negative

effectseffects Proven effective modalityProven effective modality International acceptanceInternational acceptance Cost effectiveness & affordability??Cost effectiveness & affordability??


World Health Organisation World Health Organisation (WHO) Recognition(WHO) Recognition

WHO publications surrounding Traditional WHO publications surrounding Traditional

MedicineMedicine

WHO guidelines and strategies on Traditional WHO guidelines and strategies on Traditional

MedicineMedicine

IntegrationIntegration UtilizationUtilization

EvaluationEvaluation CooperationCooperation

New Zealand participation in WHO?New Zealand participation in WHO?


Cost Effectiveness Cost Effectiveness ““Is Acupuncture for Pain Relief in General Practice Is Acupuncture for Pain Relief in General Practice

Cost Effective?”Cost Effective?”

Lindall S: Acupuncture in Medicine Dec1999 Vol17(2)Lindall S: Acupuncture in Medicine Dec1999 Vol17(2)

YES. Acupuncture is cost effective in certain pain YES. Acupuncture is cost effective in certain pain

conditionsconditions


“ “Cost Effectiveness analysis of a randomised trial of Cost Effectiveness analysis of a randomised trial of

acupuncture for chronic headache in primary care”acupuncture for chronic headache in primary care”

Wonderling D, Vickers A et al BMJ 15/03/04Wonderling D, Vickers A et al BMJ 15/03/04

Findings:Findings:

Improved Quality of LifeImproved Quality of Life

Decreased time off workDecreased time off work

Decreased medicationDecreased medication

Decreased visits to GPDecreased visits to GP


Evidence of EffectivenessEvidence of EffectivenessNational Institutes of Health (NIH) National Institutes of Health (NIH)

Consensus Conference 1997Consensus Conference 1997

Post operative nausea and vomitingPost operative nausea and vomiting

Chemotherapy nausea and vomitingChemotherapy nausea and vomiting

Post operative dental painPost operative dental pain


Reasonable Studies for Relief of PainReasonable Studies for Relief of Pain

Lateral epicondylitisLateral epicondylitis

DysmenorrhoeaDysmenorrhoea

FibromyalgiaFibromyalgia

Lower back painLower back pain

Post operative painPost operative pain


Positive Clinical TrialsPositive Clinical Trials

AddictionAddiction

Carpal tunnel syndromeCarpal tunnel syndrome

OsteoarthritisOsteoarthritis

HeadacheHeadache

Stroke rehabilitationStroke rehabilitation


Data in support of acupuncture is as Data in support of acupuncture is as

strong as for many Western medical strong as for many Western medical

therapiestherapies

Advantage is less adverse side effectsAdvantage is less adverse side effects


International Examples of International Examples of IntegrationIntegration

AustraliaAustraliaUSAUSAUKUK


Addiction ServicesAddiction Services

Reduction in withdrawal Reduction in withdrawal symptoms, relapse rates & symptoms, relapse rates & an increase in retention an increase in retention ratesrates

NADA protocol is the NADA protocol is the cornerstone of over 800 cornerstone of over 800 detox centres worldwdedetox centres worldwde


Reported successful clinical studiesReported successful clinical studies Obstetrics:- Obstetrics:- Induction, morning sickness, correction of Induction, morning sickness, correction of

abnormal foetal positions, deficient lactationabnormal foetal positions, deficient lactation

Gynaecology:- Gynaecology:- primary dysmenorrhoea, premenstrual primary dysmenorrhoea, premenstrual syndrome, infertility, menopausal syndromesyndrome, infertility, menopausal syndrome

Gynaecology & ObstetricsGynaecology & Obstetrics


Chronic / Persistent PainChronic / Persistent Pain

Prevalence estimates range from 10.1% -Prevalence estimates range from 10.1% -

55.2% of the general population55.2% of the general population

Higher in females - usually musculoskeletal Higher in females - usually musculoskeletal

originorigin

Significant use of health care resourcesSignificant use of health care resources


Clinical EvidenceClinical Evidence

““Limited evidence that acupuncture is more effective Limited evidence that acupuncture is more effective

than no treatment for chronic pain”than no treatment for chronic pain”

Systemic Review: Pain 2000 ; 86:217-225 Systemic Review: Pain 2000 ; 86:217-225

““Acupuncture found to be superior to no treatment”Acupuncture found to be superior to no treatment”

Vickers A et al Quality & Safety in Health Care2002;11:92-97Vickers A et al Quality & Safety in Health Care2002;11:92-97

““Most results favoured acupuncture”Most results favoured acupuncture”

Patel M et al International Journal of Epidemiology, Vol 18,900-Patel M et al International Journal of Epidemiology, Vol 18,900-

906 1989906 1989


Acupuncture at the Wellington Acupuncture at the Wellington Regional Pain ServiceRegional Pain Service

Available since 2000Available since 2000

Used in a variety of conditionsUsed in a variety of conditions

Limited serviceLimited service

Patients trialed 4-6 timesPatients trialed 4-6 times


THE WAY FORWARD: THE WAY FORWARD: Ideas for integrationIdeas for integration

Education Education ProgrammesProgrammes

Detoxification CentresDetoxification Centres Obstetrics and Obstetrics and

GynaecologyGynaecology

Stroke rehabilitationStroke rehabilitation Pain Clinics Pain Clinics Post operative Post operative

nausea and vomitingnausea and vomiting CancerCancer


QUESTIONS??QUESTIONS??

Thank you for your timeThank you for your time


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