Abstracts des SAR Symposion in Minneapolis

Vom 19. - 20. Oktober 2001 fand im Pillsbury Auditorium, Hennepin County Medical Center, Minnesota das 8. jährliche Symposion der Society of Acupuncture Research statt. 
Das Kongressprogramm war wie 2000 bei dem Symposion in Baltimore hervorragend und fokussierte auf den aktuellen Stand der wissenschaftlichen Forschung zur Akupunktur.
Auch der aktuelle Stand der von den National Institutes of Health geförderten, klinischen Studien wurden in Vorträgen vorgestellt und diskutiert. Wie bereits in den letzten Monaten stellen wir an dieser Stelle die Abstracts des Symposiums als Serie hier ins Netz.
Hier den 10. Teil:

Greg Goddard, Hiroyuki Karibe, Charles McNeill, Ernesto Villafuerte
Center for Orofacial Pain, Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA

Aims: The aim of this study was to compare the effectiveness of dry needling in classically recognized acupuncture points ("acupuncture") with dry needling in skin areas not recognized as acupuncture points ("sham acupuncture") in reducing masseter muscle pain in a group of patients with myofascial pain.

Methods: Eighteen patients were randomly assigned to one of two experimental groups: ten patients received acupuncture and eight received sham acupuncture. A visual analog scale (VAS) was used to measure changes in masseter muscle pain evoked by mechanical stimulation of the masseter muscle before and after the experiment.

Results: Both groups showed statistically significant reduction in VAS pain scores (p=0.001). There was no significant difference between the two groups.

Conclusion: Both acupuncture and sham acupuncture reduced pain evoked by mechanical stimulation of the masseter muscles in myofascial pain patients. However, this reduction in pain was not dependent on whether the needling was performed in standard acupuncture points or in other areas of the skin. These results suggest that pain reduction resulting from a noxious stimulus (i.e., needling) may not be specific to the location of the stimulus as predicted by classical acupuncture literature.

Eric Goldlust, Ellen Beck, Melanie Parker, Ana de Vedia
Department of Family & Preventive Medicine, School of Medicine, University of California San Diego, La Jolla, CA

Preliminary work for a modified triple-blind, randomized, controlled clinical trial of an electro-acupuncture protocol as a substitute or adjunct to local anesthesia has provided much needed but rarely published suggestions for the proper conduct of such a study.

A pilot study (n = 23) of the electro-acupuncture protocol as sole means of analgesia suggests the following guidelines:

1. Acupuncturists should adhere to a specified decision tree for such a protocol, even if such treatment is individualized by tooth or by patient's health status;
2. Study protocols should exclude the anxious patient, or may incorporate differential treatment of the anxious patient, as long as such treatment is applied effectively prior to randomization;
3. To better ascertain differences between individuals, treatment "success" should be based on a continuous scale, such as reported pain on a scale of 0-10, rather than dichotomous outcomes such as "success" of treatment; and
4. Homeless and low-income clients are sufficiently amenable to acupuncture analgesia, for reasons not formally analyzed.

A validation study (n = 24; in progress) of blinding methods in patients randomly allocated to two groups (placebo electro-acupuncture + lidocaine 2% with epinephrine 1:100,000 vs. real electro-acupuncture + lidocaine 2% without epinephrine) suggests these additional guidelines:

1. The role of the acupuncturist may be divided effectively into the roles of "practitioner" (unblinded, and responsible for needling only) and "communicator" (blinded, responsible for modification of electrical stimulation ("E-stim") during time-variable portion of study) in a manner which facilitates blinding;
2. Use of sterile callus cushions for placement of Streitberger needles (Streitberger et al '98) is superior to the ring and plaster method;
3. Novel placebo leads are an effective means of blinding the E-stim;
4. Use of active placebo assists treatment confusion by combining positive soft tissue signs with ostensibly minor effects on dental pulp;
5. Blinding is assisted by concurrent induction periods for acupuncture and anesthetic; and
6. Assessments of blinding effectiveness preceding and following post-treatment evaluations of tooth and gum sensation suggest blinding is dependent on results of evaluations.

Methods are still under development regarding blinding of E-stim in the 0-10 Hz frequency range, which is often visible to even