EBM_TCM EP_June2013分析课件.pptVIP

* Biomedical terms Veterans Health Administration (VHA) cares for almost 6 million patients: need for comprehensive assessment of approach to pain management. Diversion – divert meds form family friends – viewed as “legal”, less shameful to use, safer than illegal drugs * According to the CDC. Mostly women, white, educated, middle-upper class (disposable income), mostly seeing acupuncturists in private practice. This figure indicates it’s under-utilized, not seen as truly healthcare. 1-2% of population use acupuncture vs about 81% use physicians * * 2003-2005 Received 6 treatments + 9 additional for “sound medical reasoning,” maximum 15 Acupuncture intervention: 8-9 treatments about 30 minutes each Mean about 13 needles * 2003-2005 Marked – vast improvement of complaints Moderate- decided improvement Minimal-slight improvement Poor effectiveness – no change or deteriorated “could not be judged” 4.2 % * Conclusion: research evidence for acp as tx for LBP pretty good, OA knee also covered Show you some studies that led to that conclusion * Study of effect size of acupuncture treatment for chronic pain: back, neck, shoulder, headache, osteoarthritis Identified 29 high-quality RCTs, extracted results for nearly 18,000 patients. * Local effects – observed clinically Effects on peripheral nerves and endorphins observed in animal studies in late 70’s Current hypothesis of acp mechanism related to the effects of needling on connective tissue. Use e-microscope and ultrasound imaged to observe changes in CT Brain effects are investigated using imaging technology: fmris: in hypothalamus and amygdala seen in chronic pain case s(Napadow 2007) * “For evaluating acupuncture as a treatment modality, the existence of a plausible mechanism of action is not sufficient. Nor is it sufficient that there are practitioners with opinions about and experiences with acupuncture. The clinical history of acupuncture doesn’t constitute evidence. EBM relies on rigorous clinical investigat