COMBINATION OF MANUAL THERAPY AND ACUPUNCTURE FOR PAIN MANAGEMENT OF PATIENTS WITH KNEE OSTEOARTHRITIS. Acupuncture in Manual Therapy is a comprehensive overview of manual therapy interventions combined with acupuncture management of musculoskeletal. Two acupuncture points were selected by the manual technique, together Keywords: Acupuncture, Amitriptyline, Earache, Therapy with acupuncture, Touch.
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This retrospective study investigated the effects of combining manual therapy and acupuncture on the pain and maximal mouth opening (MMO), which were. value of acupuncture and electroacupuncture as a treatment for 1Department of Physical Therapy, Communication Science & Disorders. International Association of Acupuncture of Physical Therapists (IAAPT). Standards of media/cms/File/computerescue.info>; [Accessed 1 Jul ]. Brady S.
Lane operates part of his mobile practice in the same facility where the research was performed. Several of the participants in the research chose to become clients of Dr. Lane once the research was completed, and the call for research participants did provide a form of free advertising for Dr.
Acupuncture Physical Medicine
Abstract Despite the rise in popularity of both acupuncture and manual therapy in veterinary medicine, and the increasing number of Canadian veterinarians practising these techniques, there is little research demonstrating their effectiveness. In this repeated measures, therapeutic trial, 47 client-owned dogs with naturally occurring lameness were assessed for clinical response to treatment.
Mood and attitude also improved, but did not attain statistical significance. The recently established specialty of veterinary sports medicine and rehabilitation routinely employs both these techniques to address musculoskeletal disorders.
There are veterinarians who perform manual therapy concurrently with acupuncture as part of their regular practice when treating musculoskeletal pain. Many, including the primary author of this paper, do so because they believe that the combination of these 2 modalities yields better results than they see with either therapy alone. Despite this rise in popularity and common acceptance of these techniques, the effectiveness of acupuncture in addressing musculoskeletal pain in dogs has only been superficially examined 1 — 6.
The de qi sensation, a local sensation of achy, distension, and tingling[ 20 ], was not required and not specifically recorded. Non-penetrating acupuncture The Streitberger non-penetrating needle was used in the control group. The needle appears identical to the real needle except that it is blunt and retracts into the handle when it is pressed against the skin, giving the appearance, and sensation of needle insertion[ 21 ].
Both real and non-puncturing needles were placed at exactly the same acupuncture points and held in place by being inserted through a single-layer gauze-retaining mechanism held on by a small doughnut-shaped bandage. Acupuncturists were instructed to not to attempt to stimulate with the Streitberger needle and did not ask about the achievement of de qi to minimize the interaction between the acupuncturist and the patient.
The acupuncturists participating in the study included five licensed physicians trained in acupuncture and three non-physician acupuncturists. Physician acupuncturists all had received at least hours of medical acupuncture training.
All non-physician acupuncturists were graduates of accredited schools and licensed in the state of Pennsylvania. All practitioners were trained in the study procedures and their technique was personally observed at least once during the study by an experienced acupuncturist not participating as an acupuncturist in the trial to promote consistency of their technique.
Randomization All patients were randomized with a block size of 6, stratified by acupuncturist. The randomization coding was computer generated by an independent statistician, sealed in individual opaque envelopes, and kept in a lock box in a private room only accessible by the acupuncturist at each site. As each eligible patient was enrolled they were assigned a number in numerical order by the research coordinator, and the matching envelope was retrieved by the acupuncturist.
Blinding The patients, physical therapists, data collectors, and statistician were blinded throughout the study period. Acupuncture was performed in a separate room to limit the observation by other personnel.
The acupuncturists were not blinded due to the nature of the intervention but were trained to interact with each patient in a formalized manner to prevent unblinding. To evaluate the effectiveness of the blinding, each participant was asked at their final intervention to guess which group they were assigned true, non-penetrating, or unsure.
Our major secondary outcomes included the Brief Pain Inventory BPI [ 24 ]; the mean change in the physical and mental component scores of the item Short-Form Health Survey SF [ 25 ] and the patient global impression of change PGIC [ 26 ], using better or much better as a cut-off; and the 6-minute walk test evaluating the distance a patient could walk comfortably on a flat surface in 6 minutes before EPT using a ft.
Note: Outcome: pain changes after treatment VAS, 0—10 cm scale.
Discussion Summary of the main findings We included 12 RCTs that compared acupuncture therapy to sham acupuncture or conventional medication. With respect to reducing pain VAS 0—10 cm scale , there was moderate-quality evidence showing that real acupuncture was more effective than sham acupuncture in the short term, and similar results were obtained with low-quality evidence in the long term.
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With respect to improving the quality of life, there was low-quality evidence showing that real acupuncture was more effective than sham acupuncture in both the short and long term.
In the comparison of acupuncture vs conventional medication, we found very low-quality evidence showing that acupuncture was more effective in relieving pain in both the short and long term.
Subgroup analyses demonstrated that real MA was superior to sham MA in reducing pain VAS, 0—10 cm scale and improving the quality of life, with moderate-quality evidence in the short term and low- to very low-quality evidence in the long term.
There were two studies that compared real EA with sham EA. The results indicated real EA was superior to sham EA in reducing pain in the short term with low-quality evidence, but no significant difference was observed in the long term with low-quality evidence. Only one study compared real EA with sham EA and reported the effect on improving the quality of life.
The results demonstrated no significant difference between real EA and sham EA in both the short and long term with low-quality evidence.
A modern medical study indicated that acupuncture can significantly increase blood flow in the skin and muscles of patients with FM, 35 which is very important for reducing pain symptoms. As a primary mechanism of FM, the central sensitization of nervous system can decrease the pressure pain threshold, elicit hyperalgesia, and as a result, a noxious stimulus can cause more severe pain than in normal individuals.
EA at the bilateral Zusanli ST36 acupoints can reverse the upregulation of these receptors and reduce mechanical hyperalgesia significantly. These substances are essential to decrease the hypersensitivity of pain and reduce pain symptoms.
Therefore, more studies are needed in the future. Comparison with previous systematic reviews Previous meta-analyses have drawn various conclusions depending on the inclusion criteria and the number of included studies. However, sensitivity analysis indicated that this small analgesic effect of acupuncture was only present in studies with ROB.
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Therefore, this review concluded that acupuncture cannot be recommended for the management of FM. In , one systematic review 16 included 16 RCTs that compared acupuncture alone or combined with other interventions cupping therapy, point injection, point catgut embedding, or moxibustion to no treatment, sham, or conventional medication. The conclusion indicated that acupuncture alone or combined with cupping therapy was superior to conventional medications.
However, acupuncture had no better effect than sham acupuncture on pain reduction. Therefore, the available systematic reviews demonstrated controversial conclusions about whether acupuncture was more effective than sham acupuncture in relieving pain. Compared with previous systematic reviews, our review focused mainly on observing the efficacy of acupuncture alone, so we did not involve studies with mixed therapies.
Therefore, we extracted the results of the same tool as much as possible.
Longbottom J. (ed). Acupuncture in Manual Therapy
Because one study data of the meta-analysis were transformed from NRS, we conducted sensitivity analyses by excluding this study and found that the pooled effect was not changed. This new conclusion of our review was completely different from that of previous research and can provide a better reference for clinical decisions because we analyzed direct VAS results.
Limitations and implications This systematic review has several limitations.
First, a low number of studies were included in our review, and most of the studies had a relatively small sample size. This limitation may lead to imprecise evidence.
Second, there was considerable heterogeneity in our meta-analysis. We attempted to decrease the heterogeneity by subgroup and sensitivity analyses, but it was not completely resolved.
We considered that this heterogeneity possibly derived from methodological bias and differences in acupoint selection, sham acupuncture method, and the frequency and duration of treatment. Third, only a few studies followed-up the patients after treatment and reported adverse events; thus, studies with more details about follow-up and adverse events would better evaluate the long-term effect and safety of acupuncture.
Given the above limitations, more rigorous larger-scale and well-designed RCTs are needed to provide higher-quality evidence and evaluate the efficacy of acupuncture for FM. First, future RCTs should correctly conduct random sequence generation, allocation concealment, and blinding to avoid ROB.
Simultaneously, the details about follow-up, dropout, and adverse events must be reported thoroughly. Second, many different kinds of acupuncture are used to treat FM in clinical practice. Therefore, future studies comparing different acupuncture interventions are needed to find the most effective acupuncture treatment. Furthermore, the optimal duration and frequency of treatment are also important for FM. Third, all RCTs must be registered in advance and reported using standards for reporting interventions in clinical trials of acupuncture STRICTA guideline 43 to improve the quality of future reports in this field.
Conclusion In summary, real acupuncture was more effective than sham acupuncture in relieving pain VAS, 0—10 cm scale and improving the quality of life in both the short and long term.
Both EA and MA were better than sham acupuncture in relieving pain in the short term.The authors could find no research publications regarding the effectiveness of manual therapy in dogs, and only few papers examining the effectiveness of combined acupuncture and manual therapy CAMT , all of which were from human medicine 7 — Atlas of Extro-meridian acupuncture points.
No differences were noted by race, sex, or age. Acupuncture for osteoarthritis of the knee: We did not find any differences in effect of the puncturing and nonpuncturing acupuncture therapy when used in conjunction with EPT.