Downloaded from aim.bmj.com on December 26, 2011 - Published by group.bmj.com
who, jn thc main,.naybe seeking infort ationsolely in this countryand abroad; as
and as recently this
on his own padicLrlar topic.Perhaps clinicaltrialsin October (1991) the first issuc of the European
thosediffefent disciplinesmightbe enlighLening and Journal Clinical Hypnosis
of dcclareditselfto be:
to€lether. "Devoted to prcnoting clinical and experimental
uctive, compared
instf il
So more clinicalrepofts and more clinicaltrials,
please. needthe reassurance validat ol our
We of on It would seem as ii the readcr'schoice lies
lreatments, only to achieve
if that second declafed a
between specialised international journal,or one
objectiver "Io .juestian t|rc rale ol conplenentaty that coversa rviderrangcof topics,possibly less
in
ntedicineand itspossibleinteractianwilh orthodox clepth.Il "Complementary Therapiesin Medicine"
can achieve declared
its airn,then we shall indeed
It \\/asa braveclaimto rnakein January I993 that: have a jolrrnalof considcrable value. I saluteDr
"This v,ill be oi high quality and at1intema Lewithin hisendeavours-
Jaurnal
lionalstandard"; thc more so when the varjous
all Dr Mary lenkins BSc MB ECh DPH
subject areasalready haveotherforaavailable, both Cardhl
AbstractReviews
Byrn c, ofsson l, Falkheden L, et al. 11993) months.Psychological was
assessment carfiedoLrt
subculaneous sterile water iniectionsfor chronic beforethe first tfeatmentand at B months
neek and shoulder pain following whiplash
injuries, Irre lancet. 341:449-52
Resulls
lhis stud1, from Swcdendescribes treatment lhe ot The slerile water injections were significanlly more
chronic neck and shoulderpain due to whiplash effective than salinein tefms of rnobilityand pain
ry hf i, . u r oi 'le'ilo \^ , p ir lo riBBFpo 'll\ intensity and
inrmediately at 3 and B months,but
(TPs). Foftypatients who had been involvedin car not at 1 ..onth. Patient sellassessment Seneral ot
accidents to 6 yearspreviously
4 took part.All had improvement showcd sterilewater to be siBnifi-
pain and impairedmobility in neck and shoulders cantl,\, more eilective than salineat 3 months,but
and had difticulty in concentration. None had not at B mor]lhs. There were no adverse effects apart
to
responded conventional treatment, TENS, physio from the smarling sensations induced by the
.l'orrp) or ,,L,i I I tLrp. ThF\ \ r p r 6 B i \ F r ) injections.
_fP
srbcutancous of
injections 0.1 O.5ml at every The water injections causcdintense buminSpain,
found;20 feceived sterile waterand 20 saline. The much like that of a h/aspsting,but lasting only 30
. r L - , r p ro . l P . i n j e e . % rB F J o i l o a n . T h ' seconds. After lhis wore off, the patients generally
silesof jnjectionwere usuallythe lateralcervjcal iound that the musclc pain had disappeared and
muscles, superior
the marginof the trapeziLls, and mobilityhad increased. the
Discussing tfeatrnent in
the anteriorrotatorcLrff, severalpatients
but also had gcneral terms,wilhoul specificrelation the trial, to
TPsalongthe medialrir. of the scapulae somc the authors lhaLtheyhaveusedthistechnique
and say to
on the antcriofand posterior aspects the upper treat hundreds patients
o{ oi with vafious musculo-
anr- AJler injections been8iven, palients skeletaldisordersover the past 3 years. Most
thc had the
fesledfof 5 minutes and werc then asked move p r l e n . 5 r \ a r e q u i r e do 4 l r F r ' m p r e . . i u n . o \ F l
io I -
headand armsin various planes; any movernents 6 monthsor so; however
it the 3 treatments used in
werestillpainful, further injections weregiven. this trial may not be the opiimum and additional
The tfial was not fully double blind because lhe sessjons often beneficial.
are The JocaJ pain is a
water injections were very painful, while the saline o i . d u \ . r ' rd , l ' r ' l p r c m o J
" i, o r r r r . o f t ' n q i ' . e n .
l
was nol pajnfulat all, so there$,asno possibility The authors the
discuss mechanism action:they of
that the physlcian who gave the treatment would uEge. i mar d.o.nd or dittL'- novou'
Jlot know \a,'hich substance had been injected- AL inhibitory control" ralher than a placebo response.
weekly telephonc contacts wilh this physician the They providedetailedinstructions carryingoLrt for
patientsrepoftedwhether lhey neededa further iheir pfocedure, thar
emphasising no TPsshouldbe
treatrnent, which wasthen Siven \\,ithin or 3 da,\is. omitted and that the patienlsshould be moving
2
Eachpatient rcceived to 3 treatments the first quite freel),at the end ol Lhe scssion.
up in No local
2 months only.The results \tere analysed another anaesthetic
by shouldbe used,but premedication with
p1).;, .rr $ In l-. r ' , o l , e a , 11 l ' e p a ' n a benzodiazepine and/oran opiatecan be given.
Pajnintensity measured
was with a visualanalogue They suggest,quite justiiiably,that physicialls
scale. MobiLity was measLlred with a Myrin shouldtfy injectinB theiro\\,nforearms, that theyso
goniometer alLer firsttreaiment
the and at 1,3 and 8 knowrvhatkind oi paintheywiil bc inflicting.
in
AcupDncturc Me.li.ine 107 Nov t.)91 Vol 1t Na.2
Downloaded from aim.bmj.com on December 26, 2011 - Published by group.bmj.com
Comrnent treatment would be ineffective;they were simply
The technique described this paperclearlyhasa given to understand
in that two different types of EA
great deal in common with acupunctufej indeed, were being compared.This is in fact a mild
many medicalacupuncturists would saythat it was deception, but it was passedby the local ethical
simplyan exceptionally strongform of acupuncture. committee. Dundee(2) and lobst (3) both specifi-
It is interesting that some of the patientsare said to cally rnention usingsimilarexplanations patients
to
have had acupuncture previously,without success, in theirhistoric research.
but no information providedabout the kind of
is The patients were assessedbefore ano atter
acupuncture used, who had givenit. Would more treatmentin two ways:they filled in scoresheets
of for
frequent needlin8 withoutinjection waterleadto overallpain,pain in different
of regions, sleepqualiry
the same result,with less pain for the patient? morningstiffness, overallcondition.
and Secondly,
However the method is worth considering for an independentdoctor used a pressuregauge to
patients who fail to respond to other forms of measure the threshold muscletenderness,
of and
treatment, including plainneedling trigSer
of points. also ratedthe patient's overallcondition and useof
analgesics.
Dr Anthony Campbell MRCP FFHom The resLrhs show that all scoresin the treatedgroup
RoyalHomoeopathic Hospital.London improved remarkably,whereasthe placebo group
had no change:for example,the pain threshold
increased 70% in the activegroup,but by only
by
DeluzeC, Bosia ZirbsA" Chantraine Vischer 4% in the placebo
L, A, group. These figures were highly
TL (1992) Electroacupunctule libromyalgia: significant
in (except the caseof morningstiffness,
in
lesuffs of a controlled trial. B tish Medical for which p = 0.06).Differences between groups
the
Iournal.305:1249-52 were siBnificant 5 out of the B criteria
for
The authofs also made the observationthat about
The S\^rqq repLtation quality ard a(LLrrd, in half the tfeatment group had a moderate
lor )
clockmaking clearly extends to acupuncture improvement, quarterhad no change,while a
a
research,judging from this excellent study. lt quarter enj'oyed almostcomplete disappearance of
dramatically overturns general
the conclusions ter theirsymptorns. variation response one of
of This of is
Riet el a/. fi) that the betterthe quality of reseafch the Breatmysterie5 acupunciure
of therapy:psycho
into acupLrncture, less successful
the the treatment logicaltestinS cannotexplainthe difference, it but
seemsto be. This paper scores7470on the ter Riet may be worth lookinB at skin temperaturercsponse
criteria, highest
the yet. to EA, which the chinese are using to predict
The authors had the luck and perseverance tind success acupuncture
to in analgesia (Wong,this issue
70 patients with true fibromyalgia (this condition of the Journal: page55).
should not be confused with myofascialpain The control group {ailed to respondat all to "sham
syndromes). They madethe diagnosis according to acupuncturc",which is an interesting finding, since
strictUS criteria: Widespread
r.e. pain,tenderness the use of penetratin8
of needlesas a placebo is often
at least 11 out of 18 speci{icpoints,etc. They avoided on the grounds that they may have real
randomisedthe patienis into two gfoups: the effects.Ciearly, when you discover such a major
treatment gfoup were needledin Ll.4 and 5T,36 acupunctureeffect as is seen here, it ovefwhelms
bilaterally and in up to 6 otheracupuncture points any sliShi effect liBhtneedling.
of
chosen according to the appropriatetrigger point Six of ihe 70 patients recruited withdrewbecause
patterns. The authorscarefullyavoided needling of a worsening symptoms, of them beingin the
of 4
tender areas,so as not to causeexacerbations. They control group. The dropout rate is often not quoted
obtained chr,then gaveelectroacupuncture
De (EA) in acupuncture research papers, presumably
but in
for 30 minutes at a sufficient intensity to cause this jnstance it reflects the prevalence of strong
muscle Six
contractions. sessions wefe givenover 3 reactors the population. would be interesting
in Ii to
weeks. see wheiher there was benefit later, when the
The authorsused a frequencypatternwhich has a feactionssettleddown; anotherarea for a research
continuous sweep between 1 and 99H2, and is project.
switched alternately on and off every quarter Even Swissmechanisms occasionally falter:they
second. a
Thisseems sensible to
desi8n useuntilthe omitted to give either the duration of treatments, or
neurophysioloSists able to define the effectsof a clear statement
are that the control gfoup receivedthe
differentfrequencies more precisely. same number of needles as the treatment group.
The control group were needled subcutaneously They have clarified both these facts in a personal
20mm away from all the siteswhich would have communication. They admit that longterm follow
beenappropriate their individualpain pattern,as up was not possible, but they do quote other
for
well as 20mm awayfrom Ll.4and 5T'36. needle positivestudiesin which the resultspe|sisted.
No Lastly,
\
sensalion rs fell. bul lhey re.ei!ed genlle FA. they have not strictly shown that the benefit came
sufficieni to cause tingling, but not muscle from the EA father than the needle sensation, and
contraction. this is the only si8nificant criticism which arises in
The patients were not told ihat one type of subsequent cortespondence.
No! 'la \o/ /r \o., Acupuncture in Metl ic ine
Downloaded from aim.bmj.com on December 26, 2011 - Published by group.bmj.com
This is a powerfulstud,v, which is alreadybeinS
$,idely quoted.lt showsthat souncl gives 1 . t c r R l e tC , K l e i j n - "ji, K n p s c h l d P ( 1 ! 9 0 ) A c l P l n c l u r e n . l
research a
y
c h r o i c p a i i : a c r i t e r i ab a s e dn r e l a - a . a s s . / o u m a l o /
good suppoft for a medical approach to ClinicaI EpideniolaBy. 3 : 1191-9 I
acuplrncture, the correctuse of traditional
l.e. and 2 D u n d e e j W M c M i l l a f C M ( 1 ' r 9 2 ) s o m c p r o b l € m s
points,
tri:l8er chosenfor ernpirical, or
neulologjcal - " n c o u n t c r eid t h e s c l , " i l f i . e v a l u a t o no f a . ! p u n c t u r e
n
myofascial reasons. ll is a stimulatingexampleto anticmcsis. A.upur.rdre i, Medicinc. 10 l1): 2 I
(,
everyollepractisingacupuncture r l td
and ls so well I l o b s t C h e nl Hl , Ndc s a b l6n S r,e aar/l.e 1 9 n e schoen l ao lce.rtii .ia
l Phc on et K { 86)
s s Ts . L n - :
ol ac!pui.1!re or i i b t
argued throughout that it repays very carefu
reading.
Adrian White MA BM BCh DRCOC
BMASChaitman,Plymauth
Letter the Editor
to
Standardisation of acupuncturc teachi ng agfeedthat acupuncture part oi r.edicine and
is
thereforeshould be practisedonly by qualilied
Sir, medical practhioners, thisdoesnot nrean
but that in
Sincethe inauguration the BMAS in 1981, the the learning it we mustexc ude all that might be
of oi
Society has Sfown in stature and number ot used a basis lay acupuncture
as of teaching.
members and has a largeinternaiional standin:1. Al On the contrary, of
our knowledge acupuncturc
in
ils originthereweretwo factions the Society, one shouldbe a conrposite basic historical
of theorres
largely supporting]iaditional Chincse Medicine coupled wirh theif practise,plus ouf medrcal
(TCM)and the olher "scierii/ic"acupuncture, bLlt knowledge doctors,
as which will inclLrde scientilic
sincemy chairmanship 1982 lhescfactions
in have understandinB the relevant neurophysiology,
of
graduallymergedand forgedahead,worl
of
by side. of
an.lan assessmentihe efficacy acupuncture.
of
The passjrg of lhe Ostcopathic Bill rccently in wherc doesthis eave us?To set our teaching ol
Parliament, to enslrre standarcls osteopathic acLrpunctufe from thatof the lay practilioner,
ol apart it
praclice,has kindled the fire of enthusiasm all is possjble setoLrl
in to our own sepafate curriculum oi
who practise other complernentalyforms of learning and standardise that, as is beinBdone by
medicine,in particulalacupunctule- The fact that our Education Commiltee, and pfomote it in lhe
lay praclitionefs acupuncture
of have organised courses that are run by the BMAS.However, we if
themselves well inlo specific
so bodiessuchas the eaveout the historical of
aspects acupunctufe and
BAAB (British AcupunctlrreAccreditation Board) it's
to how it dcveloped own theorics rnethods, and jLrst
standadisetheif pracliseoi acupLrncillle, stands becausethey seem bizarre and have not been
them in good stead and speaksollt ior their provenscientifically, may very well loseoLrtin
we
p.ilmFrl.
reco8nition the future.The BAABat the present h c . 1 ; ' , ' , u u r ' d L l t t 1 u ' . I
in
tjme does not include any exclusivebodies of Lay acupuncturjsts exist,rviththcif vafious oT:lani-
doctors practising acupuncture,such as the satiofs, and they cannot bc iSnoredor swept
BMAS, who lag behind in the nalional and underglround.Most ol thcrn practise good
parliamenlary scene, acLrpuncture and :let good results. They will
This fact was emphasised the recent BMA obviouslylack the ability to diagnose
by flrlly in a
publication"Camplemenlary Medlclne",in which western sense and \!,ill not be able to supporllhe'r
the BMAS h/as not even mentionedano ooLtors history takjngand diagnosis w'th investiSations- it is
using acuplrncture werescarcely relerred except here lhat safeguards be rnadethroughliaison
to can
to sugSest if theywishedto obtaina standard
drat the
In between medically qualified and the lay pracLi-
acupunclLrre shoLrld
they haverecognised lraining in tioner. lt is thereforeimpoftani to nurture Lhis
thatsubject. relationship. Furthermore, patient's
a proBress can
So what is lhis training1o be? Are we to lcarn thus be assessed clinically and scientifically as
acupuncture comprehensively rs
from it's roots, treatraent 8rven,
oriiljnatin8 thousand
two years ago,as it is stil bcing Perhaps shouldlorge aheadfor legislation
we in
taught in China, or do we disregard that and this direction.
all The lay praclitioners wouid largely
invent our own methods- the so called tclertilic suPPort this.
acupuncru/e" advocated our Societv?
as in David LSPaine
Do not be nrisled into djsmissinS acupunctufe MB ChB MRCGP Dip Ac (Beiiing) MF Hom
based traditional
on Chlnese theorypurelybecause OrchardPaddock,Bugbrooke
this is the acupLrncture lay practitioners. are
of We NorthamplonNN7 IQR
A.upun.turc in Medicine 109 N o v t . ) 9 1 V o l1 l N o . 2
Downloaded from aim.bmj.com on December 26, 2011 - Published by group.bmj.com
Subcutaneous sterile water injections for
chronic neck and shoulder pain following
whiplash injuries
Acupunct Med 1993 11: 107-109
doi: 10.1136/aim.11.2.107
Updated information and services can be found at:
http://aim.bmj.com/content/11/2/107.citation
These include:
Email alerting Receive free email alerts when new articles cite this article. Sign up in
service the box at the top right corner of the online article.
Notes
To request permissions go to:
http://group.bmj.com/group/rights-licensing/permissions
To order reprints go to:
http://journals.bmj.com/cgi/reprintform
To subscribe to BMJ go to:
http://group.bmj.com/subscribe/