14 april 2005: Bron: South Med J. 2005 Mar;98(3):330-7.
Een grote analytische overzichtsstudie geeft een mooi overzicht van de studies die gedaan zijn met acupunctuur bij vooral kanker en geeft helder de mogelijkheden en onmogelijkheden van toepassing van acupunctuur. Achtereenvolgens het korte abstract van de studie, maar daaronder korte citaten uit een 10 pagina's groot artikel waar deze studie wordt besproken.

Acupuncture: a clinical review.
Sierpina VS, Frenkel MA

. Family Medicine Department, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA. vssierpi@utmb.edu

This article summarizes the research base, probable mechanism of actions, and clinical applications of acupuncture. It offers the clinician a deeper understanding of appropriate conditions for which acupuncture may be useful, outlines how to integrate acupuncture into a clinical practice, and describes referral and training issues.

PMID: 15813160 [PubMed - in process]

Hier een aantal korte citaten uit 10 pagina's groot medische rapport over bovengenoemde studie:
1. Although a discussion of the diagnostic and pathophysiologic metaphors of TCM is beyond the scope of this article, suffice it to say that it remains an internally coherent set of correlations based on close clinical observation, which are expressed in symbology existing for millennia. If, to our contemporary minds, such terms may seem quaint, dated, or even naíve, they are highly useful in the context of TCM. 2.Opium addicts who underwent acupuncture analgesia for surgery were noted not to go through narcotic withdrawal compared with similar patients who received conventional anesthesia. This gave birth to the endorphin hypothesis, which has been explored as one of the mechanisms of action of acupuncture. Needling affects cerebrospinal fluid levels of endorphin and enkephalin, and such effects can be blocked by the opiate antagonist naloxone. A number of other imputed mechanisms of action have used the model of the acupuncture needle as an electrode, which activates changes in the ionic milieu of the interstitial fluid, these changes being rapidly conducted along the fascial lamellar planes by the highly conductive electrolyte medium. Because nociceptive stimulation, such as with a transcutaneous electrical nerve stimulation unit, is known to block pain perception, the neurogate theory has also been suggested as a mechanism of action for acupuncture.[8]

3. Limited benefit can be expected when using acupuncture for spinal cord injuries, cerebrovascular accidents, neurodegenerative diseases, thalamically mediated pain, severe and chronic inflammatory and immune-mediated disorders, especially those having progressed to requiring corticosteroid usage, or as a primary treatment for human immunodeficiency virus infection, malignancy, or chronic fatigue states. It may, however, serve an important adjunctive role in several of these conditions by improving quality of life, reducing pain, and potentially improving immune status. Acupuncture treatment may be useful in difficult conditions such as asthenic states (tired all the time, low energy), autonomic dysregulation disorders (anxiety, sleep disturbance, bowel dysfunction), and immune dysregulation disorders (recurrent infections and inflammations). 4. As a first step in integrating acupuncture into medical care and the referral process, physicians must learn the most common indications (see Table 1 , Table 2 , and Table 3 ) or search MEDLINE or other online sources for information (http://cam.utmb.edu). In this search, the physician can look for available studies on safety and efficacy. After assessing the risk compared with the benefit, one can consider the referral. A mutual discussion with patient and family is necessary, along with documentation of such a conversation. After referring the patient, one has the continuing responsibility of monitoring the patient for benefit, adverse reactions, or failure to respond. If the patient does not respond to treatment in 4 to 10 treatment sessions, he or she should be advised to consider changing to another therapeutic approach (see Figure). ................Whenever the conventional standard of care is not effective, acceptable to the patient, or has intolerable side effects, acupuncture may be considered as one option in an integrative care plan. Although not a panacea, it is often an option physicians consider seldom or too late. 5. As an invasive technique, acupuncture has some risks, which include organ puncture, for example, pneumothorax, cardiac tamponade, damage to neural and vascular structures, infection, metal allergy, local pain, bruising, bleeding, or hematoma formation.[1,23,24] Serious injury is extremely rare, given the millions of acupuncture needles placed annually worldwide. A well-trained practitioner can prevent most such problems. Most of the case reports of adverse infectious effects published in the literature were preventable by using the introduction of safe needle technique with single-use, sterilized, disposable needles, and with such techniques, the risk of cross-transmission of HIV, hepatitis, or other infectious disease can be essentially eliminated. ..............Delaying of conventional diagnosis and treatment when using acupuncture as part of a complete medical system (TCM) is another potential risk, as the diagnostic and therapeutic methods of TCM have not been validated by scientific studies.[1] 6. Electroacupuncture should not be applied over the heart or brain or in the region of an implanted electrical device such as a pacemaker or medication pump. Hemophiliacs and others with severe bleeding disorders should be excluded from acupuncture treatment.[1],,,,,.......Patients with allergy to metal, patients taking anticoagulant drugs, and those with certain bleeding disorders must be considered on a case-by-case basis.[5] 7. Summary: The ancient method of acupuncture has gained significant popularity in our era, particularly among non-Asian populations. Because of its long history of use, safety, and reports of efficacy, more patients select acupuncture as part of their therapeutic plan. Although thorough clinical trials of the reported benefits of acupuncture as well as understanding of its mechanism of action lag behind its widespread use, physicians ought to become familiar with its potential applications for their patients. Some physicians may wish to expand the scope of his or her practice by taking additional training to administer acupuncture. However, even if one does not add this training, knowing how to refer to credible, well-trained acupuncturists and for what indications is increasingly important in the evolving model of integrative medicine, combining the best of both scientific medicine and traditional systems of care.

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