DÄGfA_WissZ_Update_Studien_Q2_2014

Transcrição

Deutsche Ärztegesellschaft
Leitung: Prof. Dr. med. Winfried Banzer, Goethe-Universität, Institut für Sportwissenschaften,
für Akupunktur e.V.
Abt. Sportmedizin, [email protected]
gegr. 1951
Wissenschaftszentrum
Stellvertretende Leitung: Dr.med. Johannes Fleckenstein, Abt. TCM/Akupunktur, Institut für
Komplementärmedizin IKOM, Universität Bern ▪ Goethe-Universität, Institut für Sportwissenschaften, Abt.
Sportmedizin, [email protected]
Tel.: 069/798 24443
Fax: 069/798 24592
e-mail: [email protected]
Sekretariat: Eszter Füzéki M.A., Goethe-Universität, Institut für Sportwissenschaften, Abt.
Sportmedizin Ginnheimer Landstr. 39, D-60487 Frankfurt /Main
DÄGfA Wissenschaftszentrum Goethe-Universität, Institut für Sportwissenschaften, Abt. Sportmedizin Ginnheimer Landstr. 39, D-60487 Frankfurt /Main
Mitgliederservice Neue Literatur 2. Quartal 2014: Aus dem WissZ
Liebes DÄGfA-Mitglied,
Anbei finden Sie eine Übersicht neuer pubmed-gelisteter Literatur mit dem Stichwort Acupuncture aus dem
2. Quartal 2014, gegliedert in folgende Abschnitte:
•
Meta-Analysen, Übersichtsarbeiten, Klinische Studien, Fallberichte, Kommentare
Es handelt sich um eine Auflistung auf der Grundlage der Artikeltypisierung der Meta-Datenbank pubmed.org der
US National Library of Medicine. Um schwerverständliche Studien in einen klareren Kontext zu setzen oder
besonders interessante Ergebnisse hervorzuheben, finden sie neu Anmerkungen zu den Abstracts sowie eine
Hervorhebung der Kernaussagen der Autoren. Bemerkenswert ist ein zunehmender Anteil an Arbeiten die neuere
Akupunkturtechniken (pharmacopuncture) darstellen, oder wie im aktuellen Fallbericht dargestellt, auf einer
invasiveren Methode gründen.
Meta-Analysen: n = 0
Relevante Übersichtsarbeiten (n = 18, davon 9 thematisch relevant sowie 4 allgemeinere Artikel )
1 C. I. Aquino and S. L. Nori. 2014. Complementary therapy in polycystic ovary syndrome. Transl Med UniSa
956-65.
Polycystic Ovary Syndrome (PCOS) is an endocrine disease. PCOS afflicts 5 to 10 % of women of reproductive age. The symptoms are:
amenorrhea, oligomenorrhea, hirsutism, obesity, infertility, chronic hyperandrogenic anovulation and acne. OTHER RISK FACTORS
AGGRAVATE THIS CONDITION: insulin resistance, obesity, hypertension, dyslipidemia, inflammation and subclinical cardiovascular
disease. Anxiety, depression and reduced quality of life are also common. This review highlights the mechanisms and the beneficial effects of
acupuncture, exercise and resveratrol on animal models and on humans affected by PCOS.
http://www.ncbi.nlm.nih.gov/pubmed/24809037
Anmerkung: Dieser Artikel berichtet unsystematisch über Wirkeffekte, Punktschemata, Akupunkturtechniken und
mögliche Wirkmechanismen in der Beahndlung des PCOS.
Deutsche Apotheker- und Ärztebank e.G.,
1. Vorsitzender: Dr. med. Wolfram Stör
Fortbildungszentrum:
Ehrenpräsidenten:
München BLZ 700 906 06
2. Vorsitzender: PD Dr. med. Dominik Irnich
PD Dr. med. Dominik Irnich
Dr. med. Walburg Marić-Oehler
Kt. Nr. 0301007262
Kassenwart:: Hedi Luxenburger
Schriftführer: Gabriela Huemer
Dr. med. Jochen Gleditsch
2 S. Cheon, et al. 2014. Pharmacopuncture for cancer care: a systematic review. Evid Based Complement
Alternat Med 2014804746.
Background. Pharmacopuncture, injection to acupoints with pharmacological medication or herbal medicine, is a new acupuncture therapy
widely available in Korea and China for cancer-related symptoms. However, the evidence is yet to be clear. Objective. To determine
pharmacopuncture's effectiveness on cancer-related symptoms. Methods. Eleven databases were searched for randomized controlled trials of
pharmacopuncture in cancer patients. The Cochrane risk of bias (ROB) assessment tool was used for quality assessment. Results. Twenty-two
studies involving 2,459 patients were included. Five trials of chemotherapy-induced nausea and vomiting (CINV) underwent meta-analysis.
Pharmacopuncture significantly relieved severity of CINV compared with control group (3 trials, risk ratio (RR) 1.28, 95% confidence interval
(CI) = 1.14-1.44). The frequency of CINV was also significantly reduced with pharmacopuncture (2 trials, RR 2.47, 95% CI = 2.12-2.89).
Seventeen trials studied various symptoms, and in most studies, pharmacopuncture significantly relieved pain, ileus, hiccup, fever, and
gastrointestinal symptoms and improved quality of life in various cancer patients. ROB was generally high. Conclusion. It may be suggested
with caution that pharmacopuncture may help various symptom relief in cancer patients, but it is hard to draw a firm conclusion due to clinical
heterogeneity and high ROB of the included studies, hence warranting further investigation.
Anmerkung: Dieser Artikel berichtet über den Wirkeffekt der pharmacopuncture bei onkologischen Patienten.
pharmacopuncture ist eine koreanische Therapieform, bei welcher medizinische Pflanzenextzrakte in die
Akupunkturpunkte injiziert werden. Eine Sub-Meta-Analyse zeigt einen Wirkeffekt bei Chemotherapie induzierter
Übelkeit und Erbrechen. Weitere krankheitsbezogene Symptome konnten in anderen Studien gelindert werden.
3 J. W. Frisk, et al. 2014. How long do the effects of acupuncture on hot flashes persist in cancer patients?
Support Care Cancer 22(5), 1409-15.
PURPOSE: Acupuncture has been suggested as therapy for hot flashes in women with breast cancer and men with prostate cancer. In this
systematic review, we sought to evaluate the long-term effects on vasomotor symptoms after the end of a defined treatment period of
acupuncture in women with breast cancer and men with prostate cancer. METHODS: A literature search revealed 222 articles within the field.
With defined exclusion criteria, we identified 17 studies. We also used the Jadad quality score and identified seven studies with a score of at
least 3. RESULTS: Six of seven identified studies qualified for inclusion in an analysis that measured frequency of hot flashes weighted in
relation to number of patients (n=172). The average reduction from baseline to end of acupuncture (ranging between 5 and 12 weeks of
treatment) showed 43.2 % reduction of hot flashes. At the last follow-up (mean 5.8 months, range 3-9 months) after the end of therapy, the
weighted reduction from baseline was sustained at 45.6 % in the 153 of 172 patients (89 %) who were followed up. CONCLUSIONS: Data
from six prospective analyzed studies indicate at least 3-month effects after the end of acupuncture treatment for flashes in women with breast
cancer and men with prostate cancer. However, larger randomized trials with long-term follow-up will be needed to confirm these preliminary
findings.
Anmerkung: Dieser Artikel berichtet über die Wirkdauer einer Akupunkturbehandlung in der Reduktion von
Hitzewallungen in Brust- und Prostata-Ca Patienten. Die Autoren berichten dass eine 5-12 wöchige Behandlung zu
mindestens 3-monatigen Effekten führt.
4 Y. H. Koog, et al. 2014. Clinically meaningful nocebo effect occurs in acupuncture treatment: a systematic
review. J Clin Epidemiol 67(8), 858-869.
OBJECTIVE: To investigate the nocebo effect using randomized acupuncture trials that include sham and no-treatment groups. STUDY
DESIGN AND SETTING: Electronic databases were searched to retrieve eligible trials from their inception until June 2013. Risk differences
were then calculated using the acupuncture and sham groups to determine the treatment effect and the sham and no-treatment groups to
determine the nocebo effect. RESULTS: In total, 58 eligible trials were analyzed. On the basis of the rate of patients with any adverse event in
31 trials reporting available data, the treatment effect was 0.012 (95% confidence interval [CI]: 0.003, 0.021), with a number needed to harm
(NNH) of 83 (95% CI: 48, 333). The nocebo effect was 0.049 (95% CI: 0.012, 0.086), with an NNH of 20 (95% CI: 12, 83). By contrast, the
rate of dropouts due to adverse events in 39 trials reporting available data showed no differences for both effects. In addition, nearly 70% of the
trials reported zero dropouts in the sham and no-treatment groups. CONCLUSION: Our findings suggest that (1) the nocebo effect of
acupuncture is clinically meaningful and (2) the rate of patients with any adverse event may be a more appropriate indicator of the nocebo
effect.
Anmerkung: Die Autoren widmen sich der Fragestellung ob durch Sham-Akupunktur auch Nocebo-Effekte
ausgelöst werden. Nocebo bedeutet ob trotz „Wirkstofffreiheit“ krank machende Auswirkungen beochbachtbar
sind. Sham-Akupunktur zeigte nicht mehr unerwünschte Ereignisse oder Drop-Outs als durch Akupunktur
vermittelt. Im Vergleich zu keiner Akupunktur war das Auftreten von unerwünschte Ereignisse bei ShamAkupunktur erhöht. Die Autoren schlussfolgern einen bedeutsamen Nocebo-Effekt. Diese Aussage beruht in der
Bewertung des WissZ auf sehr kleinen Unterschieden.
5 S. Lee, et al. 2014. The effectiveness and safety of moxibustion for treating cancer-related fatigue: a
systematic review and meta-analyses. Support Care Cancer 22(5), 1429-40.
PURPOSE: Among cancer patients, cancer-related fatigue (CRF) is one of the most common symptoms and adversely affects physical ability
and quality of life even several years after treatment. This study aims to evaluate the current evidence for moxibustion in patients with CRF.
METHODS: Eighteen databases were searched from their inception to April 2013. All randomized controlled trials (RCTs) of moxibustion for
treating CRF without language restriction were considered for inclusion. The risk of bias and reporting quality of each study were assessed
using the Cochrane risk of bias tool, Consolidated Standards of Reporting Trials (CONSORT), and Revised Standards for Reporting
Interventions in Clinical Trials of Acupuncture (STRICTA). Risk ratio (RR) or mean difference (MD) was used to measure the treatment effect
with 95 % confidence intervals (CIs) in a random effects model. RESULTS: Four RCTs with a total of 374 subjects were included for the
review. These four studies compared moxibustion plus routine care with routine care alone. Most studies were determined to have a moderate to
high risk of bias with low reporting quality. An indirect moxa stick was used in two studies, an indirect ginger cake-separated moxa was used in
one study, and in one remaining study, both moxibustion methods were used. Meta-analysis showed the favorable effects of moxibustion on the
response rate (RR, 1.73; 95 % CI, 1.29 to 2.32; p=.0003; heterogeneity, I (2)=15 %, p=.32). Burning with a mild blister after moxibustion was
reported in one study. CONCLUSIONS: Because of a high risk of bias and low reporting quality of the studies included in this review, it is
difficult to draw the conclusion that moxibustion is an effective and safe treatment for patients with CRF. Further rigorous research will be
necessary to evaluate whether moxibustion has beneficial effects on CRF. TRIAL REGISTRATION: PROSPERO. Unique identifier:
CRD42013004501.
6 K. M. Levett, et al. 2014. Acupuncture and acupressure for pain management in labour and birth: A
critical narrative review of current systematic review evidence. Complement Ther Med 22(3), 523-540.
BACKGROUND: Reviews of maternity services highlight the need for a reduction of medical interventions for women with low risk
pregnancies and births to prevent the potential cascade of interventions and their associated risks. Complementary medicines (CM) such as
acupuncture and acupressure have claimed to be effective in reducing interventions in labour; however, systematic reviews of evidence to date
are conflicting. AIMS: To examine current evidence from systematic reviews on the topic of acupuncture and acupressure for pain management
in labour and birth, and to evaluate the methodological and treatment frameworks applied to this evidence. METHODS: A search limited to
systematic reviews of the MEDLINE, CINAHL, PUBMED, EMBASE and Cochrane databases was performed in December 2013 using the
keywords 'CAM', 'alternative medicine', 'complementary medicine', 'complementary therapies', 'traditional medicine', 'Chinese Medicine',
'Traditional Chinese Medicine', 'acupuncture', 'acupressure', cross-referenced with 'childbirth', 'birth', labo*r', and 'delivery'. The quality of the
evidence is also evaluated in the context of study design. RESULTS: The RCTs included in these systematic reviews differed in terms of study
designs, research questions, treatment protocols and outcome measures, and yielded some conflicting results. It may be inappropriate to include
these together in a systematic review, or pooled analysis, of acupuncture for labour with an expectation of an overall conclusion for efficacy.
Trials of acupuncture and acupressure in labour show promise, but further studies are required. CONCLUSION: The use of current systematic
reviews of the evidence for acupuncture and acupressure for labour and birth may be misleading. Appropriate methods and outcome measures
for investigation of acupuncture and acupressure treatment should more carefully reflect the research question being asked. The use of pragmatic
trials designs with woman-centred outcomes may be appropriate for evaluating the effectiveness of these therapies.
Anmerkung: Die Autoren fassen verschiedene RCTs zur peripartalen Akupunktur zusammen mit dem Ergebnis,
dass diese in ihrer Vorgehensweise, Bewertung und Aussagekraft höchst unterschiedlich sind. Dennoch werden
diese häufig in Übersichtsartikeln zusammengefasst. Die Autoren fordern methodologisch vergleichbarere Studien.
7 T. W. Moon, et al. 2014. Acupuncture for treating whiplash associated disorder: a systematic review of
randomised clinical trials. Evid Based Complement Alternat Med 2014870271.
The aim of this systematic review was to determine the effectiveness of acupuncture for the treatment of whiplash associated disorder (WAD).
Twenty databases were searched from their inceptions to Oct. 2013. Randomised clinical trials (RCTs) of acupuncture (AT), electroacupuncture
(EA), or dry needling (DN) for the treatment of WAD were considered eligible. The risk of bias was assessed using the Cochrane tool. Six
RCTs met the inclusion criteria. Most of the included RCTs have serious methodological flaws. Four of the RCTs showed effectiveness of AT,
AT in addition to usual care (UC), AT in addition to herbal medicine (HM) or EA was more effective than relaxation, sham EA, sham EA in
addition to HM or UC for conditioned pain modulation (CPM) and alleviating pain. In one RCT, DN in addition to physiotherapy (PT) had no
effect compared to sham-DN in addition to PT for the reduction of pain. None of the RCTs showed that AT/EA/DN was more effective than
various types of control groups in reducing disability/function. One RCT did not report between-group comparisons of any outcome measures.
The evidence for the effectiveness of AT/EA/DN for the treatment of WAD is limited. Therefore, more research in this area is warranted.
8 J. Xu, et al. 2014. Safety of moxibustion: a systematic review of case reports. Evid Based Complement
Alternat Med 2014783704.
Moxibustion is a traditional medical treatment originating in China. It involves using the heat of burning moxa to stimulate acupoints. It is
considered safe and effective and is widely used throughout the world. The increasing use of moxibustion has drawn attention to the procedure's
adverse events (AEs). This review covers a total of 64 cases of AEs associated with moxibustion in 24 articles, reported in six countries. Some
evidence of the risks of moxibustion has been found in these cases. AEs include allergies, burns, infection, coughing, nausea, vomiting, fetal
distress, premature birth, basal cell carcinoma (BCC), ectropion, hyperpigmentation, and even death. The position, duration, distance between
moxa and skin, proficiency of the practitioners, conditions of the patients, presence of smoke, and even the environment of treatment can affect
the safety of moxibustion. Improving practitioner skill and regulating operations may reduce the incidence of adverse reactions and improve the
security of moxibustion.
Anmerkung: Dieser Artikel berichtet über 64 unerwünschte Ereignisse nach Moxibustion in 24 Studien. Am
häufigsten traten Verbrennungen auf (67%), seltener Allergien (11%) oder Hautinfektionen (10%). Die Autoren
bewerteten anhand einer validierten Skala die Kausalität der Ereignisse. Leider fehlt die Angabe der Fallzahl der
eingeschlossenen Studien, sowie eine Übersicht über die Bewertung aller 84 Ereignisse. So wurde beispielsweise
von den Autoren ein Basalzellkarzinom beobachtet, spezifische ausführliche Angaben über einen möglichen
Zusammenhang mit Moxibustion findet man jedoch nicht.
9 X. Yang, et al. 2014. Chinese massage (Tuina) for the treatment of essential hypertension: A systematic
review and meta-analysis. Complement Ther Med 22(3), 541-548.
BACKGROUND: Chinese massage, named Tuina, is commonly used in China and potentially effective for essential hypertension (EH).
However, there is no critically appraised evidence such as systematic reviews or meta-analyses on the effectiveness and safety of Tuina for EH.
METHODS: The following electronic databases: Pubmed, the Cochrane library, CNKI, the Wan Fang Database and VIP were searched for
published and unpublished randomized controlled trials (RCTs) of Tuina for EH up to 20th August 2013. RESULTS: Seven randomized trials
involving 479 patients were included. The results of meta-analysis showed superior effects of Tuina plus antihypertensive drugs compared to
antihypertensive drugs alone, however, Tuina alone was not superior to antihypertensive drugs. The safety of Tuina for EH was still unclear
because adverse effects were not assessed in most of the original trials. CONCLUSIONS: The findings from our review suggest that Tuina
might be a beneficial adjuvant for patients with EH, although the results are of limited value due to the clinical heterogeneity and low
methodological quality of the included studies. Future studies should adhere to high-quality RCTs with long follow-up for demonstrating the
effectiveness of Tuina for inpatients with EH.
Allgemeine Übersichtsarbeiten
1 Y. Bao, et al. 2014. Complementary and alternative medicine for cancer pain: an overview of systematic
reviews. Evid Based Complement Alternat Med 2014170396.
Background and Objective. Now with more and more published systematic reviews of Complementary and Alternative Medicine (CAM) on
adult cancer pain, it is necessary to use the methods of overview of systematic review to summarize available evidence, appraise the evidence
level, and give suggestions to future research and practice. Methods. A comprehensive search (the Cochrane Library, PubMed, Embase, and ISI
Web of Knowledge) was conducted to identify all systematic reviews or meta-analyses of CAM on adult cancer pain. And the evidence levels
were evaluated using GRADE approach. Results. 27 systematic reviews were included. Based on available evidence, we could find that
psychoeducational interventions, music interventions, acupuncture plus drug therapy, Chinese herbal medicine plus cancer therapy, compound
kushen injection, reflexology, lycopene, TENS, qigong, cupping, cannabis, Reiki, homeopathy (Traumeel), and creative arts therapies might
have beneficial effects on adult cancer pain. No benefits were found for acupuncture (versus drug therapy or shame acupuncture), and the results
were inconsistent for massage therapy, transcutaneous electric nerve stimulation (TENS), and Viscum album L plus cancer treatment. However,
the evidence levels for these interventions were low or moderate due to high risk of bias and/or small sample size of primary studies.
Conclusion. CAM may be beneficial for alleviating cancer pain, but the evidence levels were found to be low or moderate. Future large and
rigor randomized controlled studies are needed to confirm the benefits of CAM on adult cancer pain.
2 N. Hale and D. S. Paauw. 2014. Diagnosis and treatment of headache in the ambulatory care setting: a
review of classic presentations and new considerations in diagnosis and management. Med Clin North Am
98(3), 505-27.
Headaches represent the most common constellation of neurologic disorders and are a very common cause of morbidity, lost work time, and
decreased quality of life among sufferers. In this article, the diagnostic features, workup, and treatment of common, nuanced, and difficult-todiagnose headache conditions were addressed. The future will hold a number of changes, with respect to both the diagnosis and treatment of
headache disorders. As the aging population continues to grow, primary care providers will need to become increasingly familiar with
differentiating between benign primary and more serious secondary headache disorders and will need to be able to treat the headache disorders
unique to the elderly. With respect to therapeutic options, the future for treatment of the various headache disorders is promising. With the rise
in popularity of complementary medical practices, there is likely to be more research on the roles of acupuncture, herbal and alternative
remedies, massage therapy, and mind-body techniques. Further, new research is suggesting that neurostimulation may be useful in certain
chronic, intractable headache conditions. Finally, the pathophysiology of headache disorders is still poorly understood and there is great hope
that better understanding of the underlying mechanics of headache might contribute to improved treatment modalities and better quality of life
for patients.
3 P. Lieberman and D. Pattanaik. 2014. Nonallergic rhinitis. Curr Allergy Asthma Rep 14(6), 439.
Rhinitis is normally defined by the symptoms of nasal congestion, postnasal drainage, rhinorrhea, and sneezing. It has been associated with
various pathologic changes, but can occur in the absence of any inflammation. Thus, the diagnosis is based on the clinical presentation. There
are no clear-cut criteria to distinguish when rhinitis becomes chronic, but in its chronic form, it can be complex. Chronic forms of rhinitis that
occur in the absence of any detectable specific IgE against relevant aeroallergens in its broadest sense can be called chronic nonallergic rhinitis.
This review will concentrate on chronic nonallergic rhinitis in its various forms, discussing the epidemiology, underlying mechanisms, and its
therapy.
Anmerkung: In dieser Übersicht werden 2 Studien mit kleiner Fallzahl erwähnt, in welchen der Nachweis eines
Akupunktureffekts auf Symptome der nichtallergischen Rhinitis erbracht wurde.
4 L. Trevisani, et al. 2014. Colonoscopy, pain and fears: Is it an indissoluble trinomial? World J Gastrointest
Endosc 6(6), 227-33.
Colonoscopy is the reference method in the secondary prevention, diagnosis and, in some cases, treatment of colorectal cancer. It can often
cause pain associated with embarrassment, anxiety, and physical and emotional discomfort. Pain intensity is influenced by a lot of factors, and
there is a strict relationship among pain, pain perception, and mind. Several methods can be used to break the trinomial colonoscopy, pain and
fear. Sedoanalgesia is recommended by several guidelines. If no sedation is offered, the patient must accept a higher chance of unacceptable
discomfort and the endoscopist a lower chance of completing the procedure because of patient discomfort. Other non-pharmacologic methods
such as acupuncture, music, and hydrocolonoscopy can be used as alternatives to pharmacologic sedoanalgesia. Furthermore, new endoscopic
technologies such as variable-stiffness colonoscopes and ultrathin colonoscopes, or the use of carbon dioxide instead of air for colon
insufflation, can reduce the pain caused by colonoscopy. In the future, technical improvements such as wireless capsules or robotic probes, will
probably enable to overcome the present concept of colonoscopy, avoiding the use of traditional endoscopes. However, at present the poor
attention paid by endoscopists to the pain and discomfort caused by colonoscopy can not be justified. There are several methods to reduce pain
and anxiety and to break the trinomial colonoscopy, pain and fear. We must use them.
Klinische Studien: n = 2
1 M. M. Schapira, et al. 2014. Breast cancer survivors willingness to participate in an acupuncture clinical
trial: a qualitative study. Support Care Cancer 22(5), 1207-15.
PURPOSE: Acupuncture is a complementary and alternative medicine (CAM) modality that shows promise as a component of supportive breast
cancer care. Lack of robust recruitment for clinical trial entry has limited the evidence base for acupuncture as a treatment modality among
breast cancer survivors. The objective of this study is to identify key decision-making factors among breast cancer survivors considering entry
into an acupuncture clinical trial for treatment of symptoms. METHODS: Semistructured interviews were conducted among African-American
(n=12) and Caucasian (n=13) breast cancer survivors. Verbatim transcripts were made and analyzed by two or more independent coders using
NVivo software. Major recurring themes were identified and a theoretical framework developed. RESULTS: Six themes emerged reflecting key
attributes of the decision to enter a clinical trial: (1) symptom appraisal, (2) practical barriers (e.g., distance and travel), (3) beliefs about the
interventions (e.g., fear of needles and dislike of medications), (4) comfort with elements of clinical trial design (e.g., randomization, the nature
of the control intervention, and blinding), (5) trust, and (6) altruism. African-American and Caucasian women weighed similar attributes but
differed in the information sources sought regarding clinical trial entry and in concerns regarding the use of a placebo in a clinical trial.
CONCLUSIONS: Our findings contribute to the development of a theoretical model of decision making for breast cancer survivors considering
participation in a CAM clinical trial. Insights regarding the decision making process can inform interventions to support informed decision
making and robust recruitment to CAM trials among cancer survivors.
Anmerkung: In dieser Studie wurden Interviews mit 25 Brustkrebspatienten in der Remission geführt. Auf
Grundlage der qualitativen Auswertung (logistische Gründe, abhängig von der Symptomschwere, Wissen (Auch
um Sham-Akupunktur), Vertrauen, Altruismus) könnten zukünftige Forschergruppen bessere
Teilnahmebedingungen schaffen entwickeln um mehr Patienten zu einer Studienteilnahme zu motivieren.
2 B. K. Seo, et al. 2014. Bee venom acupuncture, NSAIDs or combined treatment for chronic neck pain:
study protocol for a randomized, assessor-blind trial. Trials 15132.
BACKGROUND: Chronic neck pain (CNP) is a common painful medical condition with a significant socioeconomic impact. In spite of
widespread usage, the effectiveness and safety of combined treatments between conventional and complementary alternative medical treatment
modalities has not been fully established in a rigorous randomized clinical trial (RCT). This pilot study will provide the clinical evidence to
evaluate the feasibility and refine the protocol for a full-scale RCT on combined treatment of bee venom acupuncture (BVA) and non-steroidal
anti-inflammatory drugs (NSAIDs) in patients with CNP. METHODS/DESIGN: This is a randomized, single-blind clinical trial with three
parallel arms. Sixty patients between 18 and 65 years of age with non-specific, uncomplicated neck pain lasting for at least three months will be
enrolled. Participants will be randomly allocated into the BVA, NSAIDs or combined treatment group. Assessors and statisticians will be
blinded to the random allocation. All researchers will receive training to ensure their strict adherence to the study protocol. Patients from the
BVA and combined treatment group will be treated with a bee venom increment protocol into predefined acupoints for six sessions over a three
week period. BVA intervention is developed through a comprehensive discussion among interdisciplinary spine disorder experts, according to
the guidelines of Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). Patients from the NSAIDs and combined
treatment groups will be prescribed loxoprofen (one tablet to be taken orally, three times a day for three weeks). Bothersomeness from CNP
measured using a visual analogue scale (VAS) will be the primary outcome assessed at screening, visit two (baseline), four, six, eight (4th week
assessment) and nine (8th week assessment) follow-up session. VAS for pain intensity, neck disability index (NDI), quality of life, depressive
status and adverse experiences will also be analyzed. DISCUSSION: Our study results will contribute to feasibility evaluation and to relevant
RCT protocol development for a full-scale RCT on combined treatment of BVA and NSAIDs for CNP patients. TRIAL REGISTRATION: This
study is registered with the United States (US) National Institutes of Health Clinical Trials Registry: NCT01922466.
Anmerkung: Studienprotokoll einer aktuellen Studie in welcher der Effekt von bee-venom-acupuncture mit dem
von Nichtsteroidalen Analgetika bei chronischen Nackenschmerzen verglichen werden soll. bee-venom
(Bienengift) wird wie bei der pharamcopuncture (siehe oben) in den Akupunkturpunkt injiziert.
Fallberichte: n = 1
3 T. K. Noh, et al. 2014. Infection with Mycobacterium fortuitum during acupoint embedding therapy. J Am
Acad Dermatol 70(6), e134-5.
Anmerkung: In diesem Fallbericht wird eine Infektion mit Mykobakterien nach einer acupoint embedding therapy
(AET) beschrieben. Bei der AET findet die invasive Einlage eines meist herkömmlichen chirurgischen Nahtguts
mit oder ohne Knotentechnik statt, welcher zur Verstärkung des Akupunktureffekts beitragen soll. Dies steht in
Einklang mit Berichten die ein erhöhts Haut-Infektionsrisiko bei Dauernadeln oder ähnlichen Applikationen
beschreiben.
Sonstiges: n = 12, 4 davon werden als thematisch interessant berichtet.
Anmerkung: Diese Studien sind bewusst als „Sonstiges“ kategorisiert, sie geben unvollständige, unsystematische
Beobachtungen wieder und sind als ergänzende Kommentare zur gegenwärtigen Forschungsentwicklung zu sehen.
1 A. Bhardwaj and K. Nagandla. 2014. Musculoskeletal symptoms and orthopaedic complications in
pregnancy: pathophysiology, diagnostic approaches and modern management. Postgrad Med J.
Low back pain is a common musculoskeletal symptom in pregnancy that can present as lumbar pain or pelvic girdle pain, with significant
physical and psychosocial implications. Pelvic girdle pain is more prevalent and results in greater disability than lumbar pain. It is possible to
distinguish between these two conditions from a detailed history based on the site of the pain, its intensity, disability and pain provocation tests.
Management of low back pain in pregnancy is conservative, with physical exercise for lumbar pain and minimising activities that exacerbate
pain, analgesics and bed rest for pelvic girdle pain, as well as avoiding abduction beyond the pain-free zone in labour. There is evidence that
stabilising exercises in patients with pelvic girdle pain postpartum have a beneficial effect. Other treatment modalities that have been shown to
be safe and effective include pelvic belts, transcutaneous electrical nerve stimulation, spinal manipulative therapy, acupuncture and
complementary therapy with yoga. Other orthopaedic complications in pregnancy such as carpal tunnel syndrome, pubic symphysis rupture,
transient osteoporosis and osteonecrosis are usually self-limiting with a satisfactory outcome. However, a lack of awareness and failure to
recognise these complications can result in long-term morbidity. Knowledge of the preoperative diagnostic investigations, surgical approaches
and intraoperative positioning of the mother to avoid gravid uterus compression is vital in orthopaedic emergencies such as lumbar disc
herniation, cauda equina syndrome, fractures and acute compartment syndrome of the lower limb to ensure a safe maternal and fetal outcome
and to prevent serious disability. Pregnancy is not contraindicated in women with pre-existing orthopaedic complications such as kyphoscoliosis
and total hip arthroplasty as there is no evidence to suggest increased maternal or fetal risks.
2 K. J. Cheng. 2014. Neurobiological Mechanisms of Acupuncture for Some Common Illnesses: A Clinician's
Perspective. J Acupunct Meridian Stud 7(3), 105-114.
This paper presents some previously proposed neurobiological mechanisms on how acupuncture may work in some clinical applications from a
clinician's perspective. For the treatment of musculoskeletal conditions, the proposed mechanisms included microinjury, increased local blood
flow, facilitated healing, and analgesia. Acupuncture may trigger a somatic autonomic reflex, thereby affecting the gastric and cardiovascular
functions. Acupuncture may also change the levels of neurotransmitters such as serotonin and dopamine, thereby affecting the emotional state
and craving. This mechanism may form the basis for the treatment of smoking cessation. By affecting other pain-modulating neurotransmitters
such as met-enkephalin and substance P along the nociceptive pathway, acupuncture may relieve headache. Acupuncture may affect the
hypothalamus pituitary axis and reduce the release of the luteinizing hormone in the treatment of polycystic ovary syndrome. In addition, two
other approaches to the acupuncture mechanism, the fascia connective tissue network and the primo vascular system, are briefly reviewed.
Finally, the idea of true versus sham acupuncture points, which are commonly used in clinical trials, is examined because the difference between
true and sham points does not exist in the neurobiological model.
3 X. P. Ma, et al. 2014. Acupuncture-moxibustion in treating irritable bowel syndrome: How does it work?
World J Gastroenterol 20(20), 6044-6054.
Irritable bowel syndrome (IBS) is a functional intestinal disease characterized by abdominal pain or discomfort and altered bowel habits. It has
drawn great attention because of its high prevalence, reoccurring symptoms, and severe influence on patients' lives. Many clinical studies have
demonstrated the efficacy of acupuncture-moxibustion in treating IBS. Increasing attention has been paid to research regarding the action
mechanisms of acupuncture-moxibustion for IBS, and the adoption of modern techniques has achieved some progress. This article reviews the
latest advances among action mechanism studies from the perspectives of gastrointestinal motility, visceral hypersensitivity, the brain-gut axis,
the neuroendocrine system, and the immune system. It is shown that acupuncture-moxibustion can effectively regulate the above items, and
thus, this treatment should have a high efficacy in the treatment of IBS. This article also identifies existing problems in current mechanism
research and raises several ideas for future studies. Further revelations regarding these action mechanisms will promote the application of
acupuncture-moxibustion in treating IBS.
4 C. S. Yin and S. G. Ko. 2014. Introduction to the history and current status of evidence-based korean
medicine: a unique integrated system of allopathic and holistic medicine. Evid Based Complement Alternat
Med 2014740515.
Objectives. Korean medicine, an integrated allopathic and traditional medicine, has developed unique characteristics and has been active in
contributing to evidence-based medicine. Recent developments in Korean medicine have not been as well disseminated as traditional Chinese
medicine. This introduction to recent developments in Korean medicine will draw attention to, and facilitate, the advancement of evidencebased complementary alternative medicine (CAM). Methods and Results. The history of and recent developments in Korean medicine as
evidence-based medicine are explored through discussions on the development of a national standard classification of diseases and study
reports, ranging from basic research to newly developed clinical therapies. A national standard classification of diseases has been developed and
revised serially into an integrated classification of Western allopathic and traditional holistic medicine disease entities. Standard disease
classifications offer a starting point for the reliable gathering of evidence and provide a representative example of the unique status of evidencebased Korean medicine as an integration of Western allopathic medicine and traditional holistic medicine. Conclusions. Recent developments in
evidence-based Korean medicine show a unique development in evidence-based medicine, adopting both Western allopathic and holistic
traditional medicine. It is expected that Korean medicine will continue to be an important contributor to evidence-based medicine, encompassing
conventional and complementary approaches.
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Für das WissZ, 15. Juli 2014
Prof. Dr. Dr. Winfried Banzer
Dr. Johannes Fleckenstein
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