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From: B. Harris)
Subject: Re: Menopause, arthritis, FM or ????
Date: Fri, 03 Oct 1997

In <6118am$rt7$> Karen Kay <>

>Of course. But there's a difference between saying 'acupuncture is
>bunk' and 'acupuncture is bunk for me'. You want me to say
>'acupuncture works only for me', but I can't, because I've read
>studies and seen videos and so on. If you want me to say 'acupuncture
>may not work for everyone' I'm happy to do so. But I won't say that it
>works only on a minority of people. And it's certainly something not
>to overlook if you're having any sort of persistent pain, whether it
>worked for you or not.

    It's silly to argue about whether or not acupuncture works for some
people.  Of course it does.  Pain is one of those medical phenomena
where there are no lab tests, and the report of the patient is king.
And completely irrefutable.  In fact, arguing about it gets to be
excrushiating funny once you realize what you are doing.   What-- is
the skeptic going to tell the patient that the treatment didn't really
help his pain, but rather the patient just THINKS it did?

    It is for this reason that the success of many alternative methods
in controlling pain for certain patients is (somewhat oddly) far better
established epistemologically than the success of any standard medical
therapies for many other problems.  That irks some "quackbusters" no
end, but it's logical and quite true.  In fact, you can tell something
about the rationality of a given quackbuster by how well he realizes
the inappropriateness of the skeptical positition itself, when it comes
to pain issues in medicine.

                                           Steve Harris, M.D.

From: B. Harris)
Subject: Re: Acupuncture and the nervous system
Date: 23 Jul 1998 06:20:01 GMT

In <> (Matti Narkia)

>I went on to search medline for abstracts of individual acupuncture
>antiemesis controlled trials. Here first I found in the order I found
>Anaesthesia 1997 Jul;52(7):658-661
>Acupuncture in the prevention of postoperative nausea and vomiting.
>al-Sadi M, Newman B, Julious SA
>Department of Anaesthesia, Poole Hospital Trust, UK.
>The efficacy of intra-operative acupuncture at the PC6 point in the
>prevention of postoperative nausea or vomiting was studied. A
>double-blind randomised controlled study of acupuncture versus placebo
>was performed in 81 patients scheduled for day case gynaecological
>laparoscopic surgery. Failure of treatment was defined as the occurrence
>of nausea or vomiting prior to or within 24 h of discharge. The use of
>acupuncture reduced the incidence of postoperative nausea or vomiting in
>hospital from 65% to 35% compared with placebo and after discharge from
>69% to 31% compared with placebo.
>Comment: This is a double blind trial. In the abstract sham acupuncture
>is not mentioned, but is a double blind trial possible without it?

   In my opinion, no.  So I'd like to know the answer to this question,
too.  After all, acupuncture is supposed to be more than just sticking
a needle in any old place, and promising a result (which, by placebo
effect, is bound to happen 40% of the time, and more if the procedure
is painful).

                                       Steve Harris, M.D.

>Comment: This study used acupressure and sham acupressure. Controlling
>seems to be ok.

   That depends on what the "sham wrist band" did.  Did it produce
pressure, but at the wrong point?  Or was it just band?

   The difference is important.  Much nausea is a result of
overstimulation of the parasympathetic nervous system.  Pain and
discomfort are antedotal to this kind of nausea.  A placebo for
acupuncture must produce just as much discomfort as the "correct"
procedure, or it is completely invalid.  Anybody can cause a patient
pain or discomfort, after all.  You don't need fancy Chinese training
for that, and if this is all that is going on, we can find a lot of
cheaper ways than acupuncture to do it.  Not that when anesthesia is
used with acupuncture, it does NOT work on nausea.  That result is
trying to tell us something, no doubt.

                                        Steve Harris, M.D.

> The abstract does not mention whether the result was statistically
>Acta Anaesthesiol Scand 1996 Mar;40(3):372-375
>Effect of P-6 acupressure on prevention of nausea and vomiting after
>epidural morphine for post-cesarean section pain relief.
>Ho CM, Hseu SS, Tsai SK, Lee TY
>Department of Anesthesiology, Veterans General Hospital-Taipei, Taiwan,
>Republic of China.
>BACKGROUND: Nausea and vomiting are important side effects following
>administration of epidural morphine for post-Cesarean section pain
>relief. Stimulation of the P-6 (Neiguan) acupoint is a traditional
>Chinese acupuncture modality used for antiemetic purpose; it has been
>found to be effective. The aim of this study was to evaluate the
>antiemetic effect of P-6 acupressure in parturients given epidural
>morphine for post-Cesarean section pain relief. METHOD: In a randomized,
>double-blind and controlled trial, sixty parturients receiving epidural
>morphine for post-Cesarean section pain relief were investigated.
>Parturients were allocated to receive the acupressure bands or placebo
>bands on the P-6 acupoint bilaterally before the administration of spinal
>anesthesia and were observed over a 48-hour study period. RESULTS: The
>incidence of nausea and vomiting was significantly decreased from 43% and
>27% in the control group, to 3% and 0% in the acupressure group,
>respectively (P < 0.05). CONCLUSION: The results demonstrate that
>prophylactic use of acupressure bands bilaterally on the P-6 acupoint can
>significantly reduce incidence of nausea and vomiting after epidural
>morphine for post-Cesarean section pain relief.
>Comment. This study used acupressure bands in the therapy group and sham
>acupressure bands in the control group, so controlling seems to be ok.
>The result was statistically significant.
>Anaesthesist 1993 Apr;42(4):221-226
>[Acupressure in the prevention of postoperative nausea and vomiting].
>[Article in German]
>Gieron C, Wieland B, von der Laage D, Tolksdorf W
>Klinik fur Anasthesiologie, Medizinische Fakultat, RWTH Aachen.
>Despite modern anaesthetic procedures, postoperative nausea and vomiting
>are still the side-effects most often mentioned: acupressure is reported
>to be an additional method of preventing these effects in minor
>gynaecological surgery. We investigated the effectiveness of acupressure
>in patients undergoing gynaecological operations of longer duration (6-8
>h) in a verum acupressure group compared to a placebo group. Before
>beginning the study we investigated a control group to find out the
>frequency of emesis. In the worst case of nausea that we encountered, 80%
>in the 0-6 h postoperative period, the number of random samples for the
>acupressure and placebo groups was calculated (30 patients in each
>group). The error for alpha was established at 5% and the reduction of
>nausea was 50%. METHODS. The female patients were 18 to 65 years old (ASA
>group I and II). Acupressure was carried out by fastening small metal
>bullets at the point P 6 to each forearm by means of an elastic bandage.
>The bullets were left there for 24 h. The premedication anaesthesia,
>postoperative analgesia, and antiemetic treatment were standardized.
>During a 24-h period we investigated the incidence of nausea and
>vomiting. RESULTS. The anthropometric data, the duration of surgery and
>the amount of postoperative analgesia were comparable between the three
>groups. Verum acupressure obtained a statistically significant and
>relevant reduction in nausea up to the 6th postoperative hour in
>comparison with the placebo group (P = 0.03). Nausea was reduced from 53%
>in the placebo group to 23% in the acupressure group. CONCLUSION. As
>demonstrated in this group of longer gynaecological surgery patients as
>well as in chemotherapy-induced nausea and vomiting, we were able to
>demonstrate that acupressure is an effective method of preventing nausea
>and vomiting without any side-effects. It is a valuable addition to the
>prevention of postoperative nausea and vomiting. Further studies should
>be conducted to investigate this possibility further.
>Comment. Abstract does not mention the type of placebo used in the control
>Anesth Analg 1997 Apr;84(4):821-825
>Acupressure treatment for prevention of postoperative nausea and
>Fan CF, Tanhui E, Joshi S, Trivedi S, Hong Y, Shevde K
>Department of Anesthesiology, Maimonides Medical Center, Brooklyn, New
>York 11219, USA.
>Postoperative nausea and vomiting are still common problems after general
>anesthesia, especially in ambulatory surgery. Drug therapy is often
>complicated with central nervous system symptoms. We studied a
>nonpharmacological method of therapy--acupressure--at the Pericardium 6
>(P.6) (Nei-Guan) meridian point. Two hundred consecutive healthy patients
>undergoing a variety of short surgical procedures were included in a
>randomized, double-blind study: 108 patients were in the acupressure
>group (Group 1) and 92 patients were in the control group (Group 2).
>Spherical beads of acupressure bands were placed at the P.6 points in the
>anterior surface of both forearms in Group 1 patients, while in Group 2
>they were placed inappropriately on the posterior surface. The
>acupressure bands were placed before induction of anesthesia and were
>removed 6 h postoperatively. They were covered with a soft cotton
>wrapping to conceal them from the blinded observer who evaluated the
>patients for presence of nausea and vomiting and checked the order sheet
>for any antiemetics prescribed. In both groups, the age, gender, height,
>weight, and type and duration of surgical procedures were all comparable
>without significant statistical difference. In Group 1, only 25 of 108
>patients (23%) had nausea and vomiting as compared to Group 2, in which
>38 of 92 patients (41%) had nausea and vomiting (P = 0.0058). We
>concluded that acupressure at the P.6 (Nei-Guan) point is an effective
>prophylaxis for postsurgical nausea and vomiting and therefore a good
>alternative to conventional antiemetic treatment.
>Comment. The study used acupressure bands in the therapy group and sham
>acupressure bands in the control group, so controlling seems to be ok.
>P-value was statistically significant.
>Anaesth Intensive Care 1994 Dec;22(6):691-693
>P6 acupressure and nausea and vomiting after gynaecological surgery.
>Allen DL, Kitching AJ, Nagle C
>Department of Anaesthesia, Northampton General Hospital, England.
>We studied the effect of P6 acupressure on 46 women undergoing laparotomy
>for major gynaecological surgery who received patient-controlled
>analgesia. Half the patients received acupressure at the P6 site, the
>remainder received acupressure at a "sham" site. There was a reduction in
>the requests for anti-emetic therapy in the group receiving P6
>acupressure but there was no difference in the incidence of nausea and
>vomiting. There was no difference in total morphine consumption between
>the two groups.
>Comment. The first study, where result can be considered negative,
>although there was a reduction in the requests for anti-emetic therapy in
>the therapy group.

>Anesth Analg 1993 May;76(5):1012-1014
>Transcutaneous electrical nerve stimulation reduces the incidence of
>vomiting after hysterectomy.
>Fassoulaki A, Papilas K, Sarantopoulos C, Zotou M
>Department of Anesthesia, St Savas Hospital, Athens, Greece.
>The possible postoperative antiemetic effect of transcutaneous electrical
>nerve stimulation (TENS) on the P6 point (on the Pericardium Channel of
>Hand-Jueyin) was evaluated in 103 women undergoing hysterectomy. TENS on
>the P6 point was applied 30-45 min before induction of anesthesia in 51
>patients and continued for 6 h postoperatively. The control group, 52
>patients, was treated exactly in the same way but with the electrical
>stimulator turned off. Incidence of vomiting was assessed blindly 2 h, 4
>h, 6 h, and 8 h postoperatively. The incidence of vomiting
>postoperatively was significantly less in the TENS-treated group when
>compared with the control group (between 0 h and 2 h: 23% vs 43%, P <
>0.05; between 2 h and 4 h: 27% vs 50%, P < 0.025; and between 4 h and 6
>h: 31% vs 67%, P < 0.001, respectively). Six hours postoperatively TENS
>was discontinued, and 8 h postoperatively the two groups did not differ
>significantly for incidence of vomiting (between 6 h and 8 h: 51% vs
>65%). The authors conclude that TENS reduces the incidence of vomiting
>after hysterectomy.
>Electrical stimulation acupuncture. Control group otherwise the same, but
>without eletrical stimulation. Statsisitically significant difference.
>Br J Anaesth 1989 Nov;63(5):612-618
>Effect of stimulation of the P6 antiemetic point on postoperative nausea
>and vomiting.
>Dundee JW, Ghaly RG, Bill KM, Chestnutt WN, Fitzpatrick KT, Lynas AG
>Department of Anaesthetics, Queen's University of Belfast, Ireland.
>The antiemetic action of stimulation of the P6 (Neiguan) acupuncture
>(ACP) point has been studied in women, premedicated with nalbuphine 10
>mg, undergoing minor gynaecological operations under
>methohexitone-nitrous oxide-oxygen anaesthesia. Invasive ACP--manual or
>electrical at 10 Hz--applied for 5 min at the time of administration of
>the premedication markedly reduced the incidence of vomiting and nausea
>in the first 6 h after operation, compared with untreated controls. This
>did not occur with stimulation of a "dummy" ACP point outside the
>recognized ACP meridians. Non-invasive methods (stimulation via a
>conducting stud or by pressure) were equally as effective as invasive ACP
>during the early postoperative period. However, both these non-invasive
>approaches were less effective than invasive ACP in the 1-6 h
>postoperative period, although each was as effective as two standard
>antiemetics (cyclizine 50 mg, metoclopramide 10 mg). In view of the total
>absence of any side effects in more than 500 ACP procedures, the clinical
>applications of this finding are worthy of further study.
>Electrical stimulation of the correct (P6) and incorrect acupuncture
>point. Statististical P-values are nor mentioned.
>Matti Narkia

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