Acupuncture Overview Traditional Chinese Medicine Background Conceptual basis

Acupuncture

Overview: §Traditional Chinese Medicine ØBackground ØConceptual basis ØAcupuncture §Acupuncture for Pain Management: an evidence ØPurpose ØReview of Literature ØNursing Theory based review

Traditional Chinese Medicine §Acupuncture §Massage §Traditional Herbal Remedies §Moxibustion (heat application) §Tai chi, qi gong

Qi: The vital life force The vital energy force

~361 acupoints along 12 meridians ~

Our Paper: Acupuncture: An Option for Pain Management in Primary Care

Purpose �Review acupuncture studies found in the literature �Examine theoretical frameworks that support acupuncture �Review cultural, ethical & legal issues surrounding acupuncture �Consider incorporation of acupuncture into advanced nursing practice

Review of Literature �CINAHL & Proquest databases searched �Search narrowed with keywords: Acupuncture & Pain Management � 8 studies selected analyzed

Review of Literature AUTHORS STUDY SUBJECTS METHODS RESULTS Martin, Sletten, Williams, & Berger, 2006 50 Fibromyalgia patients: (25 in control group, 25 in acupuncture group) Sham acupuncture vs. true acupuncture(6 bilateral points) FIQ score improved with acupuncture group (p=. 01) & MPI scores improved, (most in fatigue & anxiety scales) Spira, 2008 132 sailors in Iraq Acupuncture offered w/ medical treatments for sprains, fractures, etc. Return to duty 2 days (avg) sooner than conventional therapy group Tam, Leung, 36 patients from Prince Randomized, double. Li, Zhang, & of Wales Hospital w/ blind, placebo. Li, 2007 RA controlled trial analyzing effects of EA, TCA, & sham acupuncture EA group: Reduced physician global assess. scores (p=0. 04) & # of tender joints (p=0. 03); TCA group: reduced pt global assess. scores & # of tender joints (p=0. 01)

Review of Literature AUTHORS STUDY SUBJECTS METHODS RESULTS Prady, Thomas, Esmonde, Crouch, & Mac. Pherson, 2007 105 of 239 original ‘back pain trial’ participants 36 -item quality of life questionnaire addressing pain No significant differences after 7 years, although 90. 8% (treatment group) would recommend acupuncture (62. 1% of control group) White, Foster, Cummings, & Barlas, 2007 2362 patients with chronic knee pain Meta-analysis of 13 randomized control studies Suggests that acupuncture is superior to sham treatment, but need more large, quality trials Vas, Aguilar, Perea-Miller, Mendez, 2007 Patients @ Pain Treatment Unit in Spain (wide variety of nononc pain complaints) Retrospective review of 5981 records of patient treatment programs Overall favorable responses; no severe adverse events, reduced analgesic & antiinflammatory drug consumption

Review of Literature AUTHORS STUDY SUBJECTS METHODS RESULTS Lind et al, 2005 302 patients with migraine headaches in Germany Randomized control trial: acupuncture vs. sham acupuncture vs. none # of days with HA decreased in acupuncture group (from 5. 2 to 3 days) and sham group (from 5 to 2. 2 days) Reynolds, Bland & Mac. Pherson, 2008 30 IBS patients: (20 in control group & 10 in acupuncture group) Exploratory randomized control trial: general practitioner care w/ & w/o acupuncture treatment No acupuncture group: scores down 322 to 287 Acupuncture group: scores down 343 to 128.

Nursing Theory & Acupuncture �Simultaneity Paradigm: �Human being as unitary whole �Mutual, simultaneous, non-linear human- environment interaction �Health=pattern of the whole �Nursing: attempts to stimulate re-patterning

Nursing Theory & Acupuncture �Examples: �Martha Rogers’ Science of Unitary Human Beings �Rosemarie R. Parses’ Theory of Human Becoming �Susan K. Leddy’s Theory of Energetic Patterning

Cultural, Legal & Ethical Considerations �Cultural: Understand individual beliefs & needs; understand the philosophy behind healing �Legal: Referrals should be to practitioners who are board certified �Ethical: Balancing beneficence & patient autonomy

Incorporation into ANP Type Indication Respiratory Allergic rhinitis GI Biliary colic, dysentery, epigastralgia (in peptic ulcer, acute and chronic gastritis and gastrospasm Pain Facial Pain, headache, knee pain, low back pain, neck pain, dental and TMJ pain, periarthritis of the shoulder, postoperative pain, rheumatoid arthritis, sciatica, sprain, tennis elbow Gynecological and Renal colic, primary dysmenorhhea, induction of labor, correction of malposition of fetus Renal Cardiovascular Hypertension, hypotension, stroke General Adverse reactions to radiotherapy and/or chemotherapy, depression (including depressive neurosis and depression following stroke), leukopenia, morning sickness, nausea and vomiting

Contraindications �Patients on anticoagulation therapy should not participate in acupuncture due to risk of bleeding �Acute emergency cases should seek Western medical attention (ex. Shock, septicemia, hemorrhage, MI, surgical emergencies)

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