Evidencia científica acupuntura. Revisión personal

[EndSFC]

Hola a tod@s,

Me pedía en otro post KOLETXA evidencias sobre la acupuntura, a colación de un comentario que realicé al respecto tiempo atrás. Bien, he aquí un trabajo completo que hube de realizar para una asignatura de Grado de Medicina de la Universidad de Valencia, en el cual reviso ampliamente estas evidencias (EDITO: tan sólo dejo el punto de evidencias, que es del que me encargué, dado que habría de pedir permiso al resto de compañeros para publicar el resto). Expongo la totalidad de este ensayo pues creo que puede ser de interés general. Aclarar no obstante que se trata, reitero, de un trabajo personal para clase, de lo que se deduce que no tiene más valor que el que mi propia y profana cualificación pueda atribuirle. No obstante os animo a verificar las fuentes, muy sólidas--incluyendo la revisión sistemática que ofrecía aportar a quien le interesase. (Está redactado en inglés debido a que cursé esta asignatura en este idioma; siento las molestias).

Espero sea de ayuda,
Sergio




4. SCIENTIFIC EVIDENCE:
Acupuncture has traditionally been used in oriental medicine for the management of diseases and pain. Today, since acupuncture was proposed by a National Institutes of Health (NIH) consensus as a therapeutic intervention of complementary medicine (NIH, 1997), acupuncture efficacy has become more accepted in the western world.
Actually, the NIH stated in 1997:
"(...) However, promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful"
In 1996, a draft report on the clinical practice of acupuncture was reviewed at the World Health Organization Consultation on Acupuncture held in Cervia, Italy. The participants recommended that WHO should revise the report, focusing on data from controlled clinical trials.
This publication is limited to controlled clinical trials that were published up to 1998 (and in part of 1999), and only been performed for a limited number of diseases or disorders.
Only those studies who met one of the following criteria were accepted in this review:
1. Randomized controlled trials (mostly with sham acupuncture or conventional therapy as control) with an adequate number of patients observed.
2. Nonrandomized controlled clinical trials (mostly group comparisons) with an adequate number of patients observed and comparable conditions in the various groups prior to treatment.
Almost 300 controlled trials were finally analyzed.
Because of the success of surgical procedures carried out under acupuncture analgesia, the treatment of pain with acupuncture has been extensively studied. For other conditions often treated with acupuncture, there are fewer reports that have adequate methodology.
Results:
The diseases or disorders for which acupuncture therapy has been tested in controlled clinical trials reported in the recent literature can be classified into four categories:
1. Diseases, symptoms or conditions for which acupuncture has been proved—through controlled trials—to be an effective treatment:
Adverse reactions to radiotherapy and/or chemotherapy; Allergic rhinitis (including hay fever); Biliary colic; Depression (including depressive neurosis and depression following stroke); Dysentery, acute bacillary; Dysmenorrhoea, primary; Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastrospasm); Facial pain (including craniomandibular disorders); Headache; Hypertension, essential; Hypotension, primary; Induction of labour; Knee pain; Leukopenia; Low back pain; Malposition or correction of fetus; Morning sickness; Nausea and vomiting; Neck pain; Pain in dentistry (including dental pain and temporomandibular dysfunction); Periarthritis of shoulder; Postoperative pain; Renal colic; Rheumatoid arthritis; Sciatica; Sprain; Stroke; Tennis elbow.
2. Diseases, symptoms or conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed:
Abdominal pain (in acute gastroenteritis or due to gastrointestinal spasm); Acne vulgaris; Alcohol dependence and detoxification; Bell’s palsy; Bronchial asthma; Cancer pain; Cardiac neurosis; Cholecystitis, chronic, with acute exacerbation; Cholelithiasis; Competition stress syndrome; Craniocerebral injury, closed; Diabetes mellitus, non-insulin-dependent; Earache; Epidemic haemorrhagic fever; Epistaxis, simple (without generalized or local disease); Eye pain due to subconjunctival injection; Female infertility; Facial spasm; Female urethral syndrome; Fibromyalgia and fasciitis; Gastrokinetic disturbance; Gouty arthritis; Hepatitis B virus carrier status;Herpes zoster (human (alpha) herpesvirus 3); Hyperlipaemia;Hypo-ovarianism; Insomnia; Labour pain; Lactation, deficiency; Male sexual dysfunction, non-organic; Ménière disease; Neuralgia, post-herpetic; Neurodermatitis; Obesity; Opium, cocaine and heroin dependence; Osteoarthritis; Pain due to endoscopic examination; Pain in thromboangiitis obliterans; Polycystic ovary syndrome (Stein–Leventhal syndrome); Postextubation in children; Postoperative convalescence; Premenstrual syndrome; Prostatitis, chronic; Pruritus; Radicular and pseudoradicular pain syndrome; Raynaud syndrome, primary; Recurrent lower urinary-tract infection; Reflex sympathetic dystrophy; traumatic Retention of urine; Schizophrenia;, drug-induced Sialism; Sjögren syndrome; Sore throat (including tonsillitis); acute Spine pain; Stiff neck; Temporomandibular joint dysfunction; Tietze syndrome; Tobacco dependence; Tourette syndrome; Ulcerative colitis, chronic; Urolithiasis; Vascular dementia; Whooping cough (pertussis)
3. Diseases, symptoms or conditions for which there are only individual controlled trials reporting some therapeutic effects, but for which acupuncture is worth trying because treatment by conventional and other therapies is difficult:
Chloasma; central serous Choroidopathy; Colour blindnessDeafness; Hypophrenia; Irritable colon syndrome; Neuropathic bladder in spinal cord injury; Pulmonary heart disease, chronic; Small airway obstruction
4. Diseases, symptoms or conditions for which acupuncture may be tried provided the practitioner has special modern medical knowledge and adequate monitoring equipment:
Breathlessness in chronic obstructive pulmonary disease; Coma; Convulsions in infants; Coronary heart disease (angina pectoris); Diarrhoea in infants and young children; viral Encephalitis in children and in late stage; progressive bulbar and pseudobulbar Paralysis.
A more recent study, analyzed 45 complementary and alternative medicine efficacy randomized controlled trials from high-impact medical journals. Although it concludes that in general, complementary and alternative medicine therapies are no more effective than placebo, as for acupuncture, it only analyses 8 studies, from 2002 to 2009, looking for the efficacy of 5 conditions: Back pain, migranes, neck pain, cocaine addiction, ostheoarthritis, subacute stroke rehabilitation. 4 out of the 8 studies analyzed show positive results, but were discarded as valid studies because they didn't meet their established criteria.

Out of the 5 conditions this analysis review examined, 2 are listed by the WHO as an effective treatment. This study fails to include the 5 studies the WHO analyzed to reach the positive conclusions on chronic back pain and also didn't include the 11 studies concerning the headaches, that lead to the authors representing the WHO to conclude: "For tension headache, migraine and other kinds of headache due to a variety of causes, acupuncture has performed favourably in trials comparing it with standard therapy, sham acupuncture, or mock transcutaneous electrical nerve stimulation (TENS)".

In conclusion, this more recent study on complementary and alternative medicine efficacy includes very few studies in order to reach valid conclusions.


5. CONCLUSSION:

Absence of a convincing model of sham acupuncture and the fact that its therapeutic effects depend greatly on the proficiency of the acupuncturists, makes it difficult for most studies on this therapy to meet the western medicine standards in order to provide strong evidence. These obstacles seem however be slowly improving during the last decade. Nevertheless, in spite of these impediments, the available data has been enough for two of the main international official health organization, the NIH and the WHO, to recommend acupuncture as a therapy of choice to be used together or even before the conventional treatments. Thus, the WHO, after examining almost 300 studies who met high scientific methodological standards, stated that, out of the 105 conditions reviewed, acupuncture had proved to be useful for 26 of them; for other 63 therapies examined, therapeutic effect of acupuncture was shown but needed further proof; finally, for other 16 conditions, acupuncture was also recommended under certain circumstances. Important to note that these organizations, as well as many other sources, also highlight the need for better and further research on the field.

In conclusion, considering the non-toxic nature and the minimal adverse reactions demonstrated by acupuncture, it seems reasonable to at least consider this discipline as a real alternative for some conditions, and to try to get rid of our prejudices towards it, what would lead to a better understanding and to the necessary performance of further and better designed research.

Bibliography:
- Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials. WHO, 2002.
- Acupuncture. NIH Consensus Statement Online 1997 Nov 3-5; month, day]; 15(5):1-34.
- Neural mechanism underlying acupuncture analgesia. ZHI-QI ZHAO. Progress in Neurobiology 85 (2008) 355–375.
- CORRAL, JOSÉ LUIS. Curso de acupuntura. 4a. ed. Madrid: Miraguano, 2008.
- GU J, WANG Q, WANG X, ET AL. Assessment of Registration Information on Methodological Design of Acupuncture RCTs: A Review of 453 Registration Records Retrieved from WHO International Clinical Trials Registry Platform. Evid Based Complement Alternat Med. 2014;2014:614850
- SAAD, MARCELO MD, PHD. Acupuncture: Concepts and physiology. Rijeka, Croatia: InTech, 2011.
- ZHAO, Z. Neural Mechanism Underlying Acupuncture Analgesia. Progress in Neurobiology 85.4 (2008): 355-375.
- HAN, JI-SHENG. Physiology of Acupuncture: Review of Thirty Years of Research. The Journal of Alternative and Complementary Medicine 3.supplement 1 (1997): s-101-s-108
- ZHAO, Z. Neural Mechanism Underlying Acupuncture Analgesia. Progress in Neurobiology 85.4 (2008): 355-375
- . JUNHUA ZHANG A, HONGCAI SHANG A, XIUMEI GAO ET AL. Acupuncture-related adverse events: a systematic review of the Chinese literature. Bulletin of the World Health Organization 2010;88:915-921C
- R. BARKER BAUSELL. Are Positive Alternative Medical Therapy Trials Credible? Evidence From Four High-Impact Medical Journals. Eval Health Prof 2009 32: 349

[koletxa]

Hola a tod@s,

Gracias Sergio. Pedí esta información, al leer un hilo de 2014.
Yo llevo varios años, antes de confirmarse mi enfermedad de lyme y coinfecciones, acudiendo a sesiones de acupuntura. La verdad es que para algunas cosas me va muy bien; concretamente dolores articulares, musculares, problemas respiratorios y ansiedad. Evidentemente no todas las sesiones son igual de eficaces.

Al igual que en la medicina "oficial", en las "alternativas" existen much@s caraduras que se aprovechan de nuestr@s problemas para sacarnos dinero sin
ningún miramiento. Por ello, es muy importante dar con personas que controlan la materia que ofrecen, cosa que no es nada fácil.

El acupunturista al que yo acudo, es médico y me parece que controla bastante esta disciplina, sin embargo tiene demasiados pacientes y dedica poco tiempo a interesarse y escuchar al paciente. Por otra parte la consulta está muy descuidada.

Si alguién de vosotros conoce algún acupuntor fiable por Gipuzkoa y/o Navarra, que me lo haga saber, por favor.

Saludos