Developing a Research Strategy for Acupuncture

Introduction

The development of a research strategy for acupuncture, as part of the broader field of complementary and alternative medicine (CAM), is a complex and multifaceted task. This endeavor is influenced by a variety of factors, including the historical context, political climate, and the evolving nature of the field itself. The following article draws upon the initiatives that have been central to the development of CAM research capacity in the United Kingdom, Canada, and the United States over the last decade.

The Historical Context

The development of CAM research has been championed by both patients and politicians, primarily to better understand the popularity and apparent effectiveness of these therapies and support integration of safe and effective CAM in health care. Over the last 10 years, CAM research capacity has developed apace with several leading research departments, now offering an established research and research training environment. While CAM is not new, it is now being addressed in a much more formal way than before, particularly in North America.

The Role of Funding

Funding plays a crucial role in the development of a research strategy for acupuncture and other CAM therapies. In the United States, the United Kingdom, and Canada, various sources of funding have been identified for CAM research. These include governmental funding sources, private foundations, and institutional support. The funding supports research projects, research fellowships, and centers of expertise.

The Emergence of a Research Strategy

The emergence of a research strategy for acupuncture and other CAM therapies has been a gradual process. In the United Kingdom, for instance, this involved physicians both practicing and researching within CAM and encompassed the development of research within acupuncture, homeopathy, and manipulative medicine, in particular chiropractic. In Canada, a CAM research community started to develop in the late nineties, largely due to support from Health Canada. In the United States, formal institutional support of research into complementary and alternative health care began approximately 15 years ago.

Future Directions

The future of CAM research, including acupuncture, is envisioned as an important interdisciplinary and international research effort. Practitioners, both CAM and conventional, will need to build their research literacy and capacity, and researchers need to become more knowledgeable about CAM practices and/or include CAM practitioners on their teams. CAM research will positively impact conventional medicine, particularly in broadening its perspective and understanding of the contextual, relational, and non-specific factors that affect health outcomes.

The development of a research strategy for acupuncture is a dynamic and evolving process that requires a multifaceted approach, including the consideration of historical, political, and funding factors. As the field continues to grow and evolve, it is crucial to continue to refine and adapt research strategies to ensure the continued advancement and integration of acupuncture and other CAM therapies into mainstream health care.

Research projects done on acupuncture

1). The process of acupuncture treatment. A randomised controlled trial and qualitative study to evaluate the relative contributions of specific and non-specific effects.

Investigators: Peter White, George Lewith

Funded by:  Department of Health (£181,496); Garfield Weston Foundation   (£10,000)

Summary: The efficacy of any treatment is inherently bound up with the delivery system employed to provide that treatment and its associated non-specific effects. We propose to investigate the patient/ practitioner interaction and context of acupuncture treatment within a randomised controlled trial (RCT). This will involve 2 practitioners, treating patients with osteoarthritic pain, specifically investigating the clinical effects, on pain, of real acupuncture and different currently available acupuncture placebo controls. The results of this study may have broad implications for other physical treatments employed in painful conditions.
Aims: 1) To investigate the relative effects of different currently used acupuncture placebo controls, 2) To evaluate the specific effects of acupuncture on pain, in a population of patients with severe OA knee or hip, awaiting joint replacement. 3) To evaluate the effects of patient/ practitioner interaction on outcome.
Hypotheses: Primary. A) Needles cause an enhanced placebo effect in acupuncture treatment which will affect clinical outcome. B) Acupuncture is more effective than placebo in the treatment of O.A. hip/ knee. Secondary: Empathic consultations are more effective than non-empathic consultations
Background: Complementary and Alternative Medicine (CAM) is widely used, Thomas et al indicate that 10% of the U.K. population use CAM annually and 47% are lifetime users, whilst Ernst and White suggests a U.K annual expenditure of  £1.6 billion. Acupuncture is one of the most widely used CAM therapies and 0.6 million individuals received this treatment in 1998. This popularity is not sustained by a strong evidence base, as indicated by the recent House of Lords report.

2). The Effects of Acupuncture Versus Placebo Controls in Various Treatments

Abstract

This paper aims to investigate the effects of acupuncture versus placebo controls in various treatments. It draws upon a comprehensive review of the characteristics of placebo needles and how they differ from placebo pills in two aspects: physiological response and blinding efficacy. The paper argues that placebo needles elicit physiological responses similar to real acupuncture and therefore provide similar clinical efficacy. It also discusses the efficacy of placebo needles supported by ineffective blinding, which may lead to opposite guesses that further enhance efficacy, as compared to no-treatment, e.g., with waiting list controls.

Introduction

Acupuncture, a therapeutic intervention involving the insertion of one or more needles into specific sites on the body surface for therapeutic purposes, has been the subject of numerous randomized controlled clinical trials (RCTs). Placebo needles were developed and validated to evaluate the efficacy of acupuncture treatment in these trials. However, the adequacy of the controls being used in these studies remains to be determined. This paper reviews the physiological actions of placebo needles, the blinding components of placebo needles, and discusses alternative control strategies.

Physiological Actions of Placebo Needles

Placebo needles, much like real acupuncture needles, can induce tactile sensations around the acupoints. These tactile sensations themselves could produce physiological actions through the body in acupuncture trials. The somatosensory system is activated directly by placebo needles, which exert various physiological actions in the body that are similar to those exerted by real acupuncture needles. Real and placebo needles produce enhanced skin conductance responses and decrease the heart rate, suggesting that placebo needles are not physiologically inert in terms of autonomic response patterns.

Blinding of Placebo Needle Applications

Blinding is another important issue that can minimize bias or the potential effect of context on the outcomes of RCTs. The blinding index (BI) was developed to assess the success of blinding in clinical trials. However, people more often respond to placebo needles because they are more likely to believe that they are receiving active treatment, which is also known as an opposite guess. Patients may have higher levels of expectation during placebo needling than when receiving placebo pills, which could contribute to treatment efficacy.

Alternative Control Strategies

When blinding becomes difficult or even impossible, alternative control strategies are required to separate specific therapy effects from unspecific effects as well as from spontaneous remission and response biases. Ineffective or impossible blinding also precludes conventional cross-over designs where each patient serves as his/her own control, thereby reducing the data variance and allowing trials with far fewer patients than with a parallel-group design.

Conclusion

The paper concludes that placebo needles elicit physiological responses similar to real acupuncture and therefore provide similar clinical efficacy. It also demonstrates that this efficacy is further supported by ineffective blinding, which may lead to opposite guesses that further enhance efficacy, as compared to no-treatment, e.g., with waiting list controls. The paper suggests that future research should focus on developing more effective control strategies for acupuncture trials.

3). Context and Outcomes in Acupuncture

Investigators:  Felicity Bishop, George Lewith

Funded by:  Southampton Complementary Medicine Research Trust and the Korean Pharmacopuncture Institute (£45, 085).

This study will contribute to the development of a model of the psychosocial predictors of treatment effects, using acupuncture as a treatment model. Therapeutic effects have two components: specific effects and non-specific effects (including the natural history of the disease). Specific effects are a direct result of the particular therapeutic agent involved in a treatment, while non-specific effects result from the context within which the specific therapeutic effect is provided. In complex interventions such as acupuncture, specific and non-specific effects and the factors that might cause or facilitate these effects are difficult to identify and distinguish. Previous research has investigated individual factors including expectancy and the therapeutic relationship. The aim of this project is to identify the psychosocial context factors that might contribute to treatment outcomes in acupuncture. The objective of this study is to identify and describe factors that form part of patients’ experiences of acupuncture. The study uses qualitative methods (individual semi-structured interviews with patients, Framework Analysis).

Bishop FL, Lewith GT. A review of psychosocial predictors of treatment outcomes: what factors might determine the clinical success of acupuncture for pain? J Acupunct Meridian Stud. 2008; 1(1): 1-12

4). Cutaneous blood flow responses to acupuncture

Investigators:  Val Hopwood/Geraldine Clough/George Lewith/Martin Church

Funded by:  AACP (£6,624).

Benefits the proposed investigation will bring to acupuncture/physiotherapy / patient care
A clearer understanding of the mechanisms involved in the response to acupuncture.
Purpose
The aim of this study is to assess cutaneous blood flow responses to acupuncture and to investigate whether there is a difference in blood flux between a commonly used acupuncture point (UB 23) and a non acupuncture point, both without producing  Deqi (needling sensation) and with needle manipulation designed to elicit Deqi on purpose.

Our primary research questions are:
1.   Is baseline blood flux different at a commonly used acupuncture point (UB 23) compared with a non acupuncture point?
2.   Are there differences in blood flux between an acupuncture and non acupuncture point when an acupuncture needle is inserted?
3.   Are there differences in blood flux between an acupuncture point and a non acupuncture point when acupuncture needling designed to elicit Deqi occurs?
Our secondary research question is:
4.   Is there a relationship between the blood flux responses and the beliefs and expectations of the individual?
We aim to test the hypothesis that there is a difference in the cutaneous blood flow response to acupuncture at an acupuncture site compared with a non acupuncture site and that these differences may vary when Deqi occurs.
The outcome of this study will be a better understanding of a safe and non invasive technique through which we can investigate the underlying vaso-responsive mechanisms of acupuncture as well as the various physiological and psychological factors that may predict and influence the clinical response to treatment.

5). The evaluation of acupuncture for pain with fMRI (TEAM); neural pathways and experimental models.

Investigators:Peter White, George Lewith, Hugh MacPherson, Gary Green, Azia Asahar, Tony Jones.

Our primary objectives are to use fMRI to:(i) investigate the effects of the “placebo” (retractable) Streitberger needle to ascertain if it is a true acupuncture placebo, (ii) to identify the specific neurological components that are activated/deactivated by real acupuncture alone and that correlate with clinical improvement and (iii) to ascertain if we should use patients in chronic pain or healthy volunteers to research the effects of acupuncture in pain. Implicitly these studies will impact on imaging/pain research. Obtaining answers to these questions will be essential to enhance our understanding of acupuncture’s underlying neural mechanisms which in turn will enable us to design better and more meaningful clinical trials, thus allowing scarce clinical research resources to be used in a more efficient manner.

6). Acupuncture for pre-partum and intra-partum care.

Investigators: Amali Lokugamage and Rachel Ambler – Whittington Hospital/James Raftery – HTA/George Lewith

Acupuncture involves fine needles being inserted into the body. It is safe alongside conventional medicine for pain relief, nausea/vomiting and to maintain health and promote well-being. Acupuncture for pregnant women may reduce vomiting, improve pain and mobility and lessen the overdue pregnancy rate thereby reducing the rate of labour induction and possibly caesarean sections. It can alleviate anxiety and so reduce the need for pethidine and epidurals. Users report great satisfaction. Direct written quotes (Whittington) say: “I found this treatment very useful and resulted in less medical intervention, I would recommend it to my friends”; “Feel that this is a great option and is effective — excellent value for my tax. Please continue”; “I am really grateful that this service is available. I’m feeling relaxed and in great hands”. We would like to investigate if birth preparation as a consequence of using our demand-led acupuncture service can improve our maternity service, reduce our intervention rate, is cost effective and whether it enhances women’s experience of pregnancy and birth. We recognize that an RCT would be valuable in this area, but we know from respected journals that observational studies such as this proposal can also provide valuable evidence, while taking into account vital and clinically relevant aspects of client choice and expectation. This is an ideal opportunity to pragmatically evaluate a current service. Research into complementary medicine within the NHS is under funded so this is also a unique opportunity to improve the evidence as well as provide feasibility data for the methodology required for a definitive trial involving patient preference. This type of study approach involves maternal choice – an important factor in optimising the outcomes and experiences of pregnancy. The Whittington Hospital serves a very diverse community, a further reason to provide services respecting client choice.

7). Acupuncture for the treatment of low back pain within an out-patient physiotherapy management programme.

Investigators: Peter White/George Lewith/Lisa Roberts/ Phil Prescott and James Rafferty

We are in the process of developing a pragmatic randomised clinical trial evaluating the use of acupuncture as an additional therapy in the treatment of sub-acute low back pain referred to physiotherapy.This will involve evaluating the cost effectiveness of adding acupuncture to the already existing protocol for treatment of back pain and will also evaluate whether dose of acupuncture is important.


8). The Acupuncture Trialists Collaboration: individual patient data meta-analyses of chronic pain trials.

Investigators: Andrew Vickers, George Lewith, Claudia Witt, Klaus Linde et al.

We aim to combine raw data from high quality randomized trials of acupuncture for chronic pain to create an individual patient level data set. This data set will be analyzed to determine the effect size of acupuncture and modifiers thereof. After publication of the principal results of these analyses, a de-identified (i.e. anonymized) raw data set will be posted on an Open Access website for the benefit of the acupuncture research community as a whole.

9). Acupuncture for Back Pain: Evaluating Patient Outcomes and Their Determinants

Investigators: Felicity Bishop, George Lewith, Cyrus Cooper, Lucy Yardley.

Back pain has severe consequences and affects 36% of the UK population. Acupuncture is a popular and effective back pain treatment, but its mechanism is poorly understood. This research develops psychological theory to investigate the determinants of patient outcomes of acupuncture for back pain. The purpose is to improve our understanding of the psychological mechanisms involved. Three linked studies are planned. A prospective postal longitudinal questionnaire study will test theoretically grounded hypotheses concerning the predictors of outcome in acupuncture. A nested qualitative interview study will analyse patients’ unsuccessful experiences of acupuncture. A booklet will be designed to alter patients’ beliefs about acupuncture and back pain, and a randomised controlled trial of the booklet will determine whether patients’ beliefs have a causal role in acupuncture outcomes and whether the booklet is effective in improving patient outcomes. There will be implications for understanding and researching related conditions and treatments.

10). Adjuvant acupuncture care for breast cancer patients experiencing side effects from chemotherapy. A randomised controlled pilot and feasibility study.

Investigators: Sameline Grimsgaard, Sarah Price, Terje Alræk, Terje Risberg
Steering group: Sarah Price, George T Lewith, Sameline Grimsgaard, Terje Risberg, Terje Alræk

Aim of study
1 Develop an acupuncture treatment protocol for adjuvant acupuncture care for breast cancer patients undergoing chemotherapy using structured interviews with established acupuncture teams in Norway.
2 Implement the treatment protocol in a pilot study to evaluate outcome measures, effect sizes and acceptability of acupuncture care delivered alongside conventional care.
Study results will support the design of future research; including a Phase III randomised controlled trial1 that combines rigorous research methodology with an authoritative and well-defined intervention and outcomes that assess the effect of acupuncture care for this group of patients.

11). Brain imaging of acupuncture: comparing superficial and deep needling

Investigators: MacPherson H, Green G, Nevado A, Lythgoe MF, Lewith G, Devlin R, Haselfoot R, Asghar AUR

Status: Study completed, 1 paper published

MacPherson H, Green G, Nevado A, Lythgoe MF, Lewith G, Devlin R, Haselfoot R, Asghar AUR.  Brain imaging of acupuncture: comparing superficial and deep  needling. Neuroscience Letters. 2008; 434: 144-149.

The difference between superficial and deep needling at acupuncture points has yet to be mapped with functional magnetic resonance imaging (fMRI). Using a 3 T MRI, echo planar imaging data were acquired for 17 right-handed healthy volunteer participants. Two fMRI scans of acupuncture needling were taken in random order in a block design, one for superficial and one for deep needling on the right hand at the acupuncture point LI-4 (Hegu), with the participant blind to the order. For both scans needle stimulation was used. Brain image analysis tools were used to explore within-group and between-group differences in the blood oxygen level dependent (BOLD) responses. The study demonstrated marked similarities in BOLD signal responses between superficial and deep needling, with no significant differences in either activations (increases in BOLD signal) or deactivations (decreases in BOLD signal) above the voxel Z score of 2.3 with corrected cluster significance of P = 0.05. For both types of needling, deactivations predominated over activations. These fMRI data suggest that acupuncture needle stimulation at two different depths of needling, superficial and deep, do not elicit significantly different BOLD responses. This data is consistent with the equivalent therapeutic outcomes that are claimed by proponents of Japanese and Chinese styles of acupuncture that utilise superficial and deep needling, respectively.

12). Acupuncture needling sensation: the neural correlates of deqi using fMRI

Investigators: Asghar AUR, Green G, Lythgoe MF, Lewith GT, MacPherson H

Status: Study completed, 1 paper in press

Asghar AUR, Green G, Lythgoe MF, Lewith GT, MacPherson H.  Acupuncture needling sensation: the neural correlates of deqi using fMRI.  (Brain Research).

The needling sensation of deqi is considered by most acupuncturists to be an important component of acupuncture, yet neuroimaging research that investigates this needle sensation has been limited. In this study we have investigated the effect of deqi and acute pain needling sensation upon brain fMRI blood oxygen level-dependent (BOLD) signals.

Seventeen right-handed participants who received acupuncture at LI-4 (hegu) were imaged in a 3T MRI scanner. fMRI datasets were classified into those that were associated with predominantly deqi sensations versus those with predominantly acute pain, based upon the participants’ reports of needling sensations. Regional changes in BOLD signal increases (activations) and decreases (deactivations) were identified.

Differences were demonstrated in the pattern of activations and deactivations between groupings of scans associated with deqi versus pain sensations. For the deqi grouping, significant deactivations occurred, whereas significant activations did not. In contrast, the predominantly acute pain grouping was associated with a mixture of activations and deactivations. For the grouping associated with deqi sensations, after subtracting the acute pain grouping (deqi >pain), we observed deactivations in limbic/sub-cortical structures and the cerebellum.

Our results show the importance of collecting and accounting for needle sensation data in neuroimaging studies of acupuncture.

13). The effects of acupuncture versus placebo controls in the treatment of disabling breathlessness.

Investigators:  Clare Hill/George Lewith

Funded by:  Garfield Weston Foundation (£25,000); Dr Susil Kumar & Jamila Mitra Charitable Trust (£10,000).

Status:  Pilot completed and published, definitive study completed and 2 papers published.

(1) Davis CL, Lewith GT, Broomfield J, Prescott P.  A pilot project to evaluate the effects of acupuncture versus two control interventions in the treatment of disabling breathlessness.  Journal of Alternative and Complementary Medicine.  2001; 7(6): 633-639.

 


(2) Lewith GT, Prescott P, Davis CL.  Can a standardised acupuncture technique palliate disabling breathlessness: a single blind, placebo controlled, crossover study.  Chest.  2004; 125 (5): 1783-90.

14). The placebo/Streitberger needle.  A series of clinical trials and imaging experiments (PET) to evaluate its validity and the underlying mechanism of acupuncture

Investigators:  Peter White, George Lewith, Val Hopwood and Phillip Prescott

Status:  Study completed and paper published. White P, Lewith G, Hopwood V, Prescott P.  The placebo needle, is it a valid and convincing placebo for use in acupuncture trials?  A randomised, single blind, cross-over trial.  Pain. 2003; 106 (3): 401-409.

The issue of what constitutes an effective and realistic acupuncture placebo control has been a continuing problem for acupuncture research. In order to provide an effective placebo, the control procedure must be convincing and should mimic, in all respects, apart from a physiological effect, the real active treatment. To be truly credible, the placebo should be visible to the patient and it should appear as though the skin is being penetrated, The ‘Streitberger’ needle might fulfil these criteria and this paper reports on a validation study.
Method: This was a single blind, randomised (to practitioner and treatment sequence), cross-over pilot study and subjects were stratified for gender and joint type. Patients were drawn from the orthopaedic hip and knee, joint replacement waiting list. Intervention consisted of either 2 weeks of treatment with real acupuncture followed by 2 weeks on placebo, or vice versa. The prime outcome was a needle sensation questionnaire and there was a range of secondary outcomes.
Results 37 patients were randomised and completed treatment. Groups were well balanced at baseline. No significant differences between groups or needle type were found for any of the sensations measured. Most patients were unable to discriminate between the needles by penetration however nearly 40% were able to detect a difference in treatment type between needles.
Conclusion No major differences in outcome between real and placebo needling could be found. The fact that nearly 40% of subjects did not find that the two interventions were similar however, raises some serious concerns with regard to the wholesale adoption of this instrument as a standard acupuncture placebo. Further work on intertester reliability and standardisation of technique is highly recommended before we can be confident about using this needle in further studies.

15). The placebo effects of acupuncture.

Investigators:  Peter White/George Lewith

Funded by:  Elizabeth, Lady Cowdray’s Charity Trust (£5,000)

Status:  Pilot study completed and 1paper published, 1 in press.

(1) White P, Lewith G, Hopwood V, Prescott P. The placebo needle, is it a valid and convincing placebo for use in acupuncture trials? A randomised, single blind, cross-over trial.  Pain. 2003; 106 (3): 401-409.

Introduction The issue of what constitutes an effective and realistic acupuncture placebo control has been a continuing problem for acupuncture research. In order to provide an effective placebo, the control procedure must be convincing and should mimic, in all respects, apart from a physiological effect, the real active treatment. To be truly credible, the placebo should be visible to the patient and it should appear as though the skin is being penetrated, The ‘Streitberger’ needle might fulfil these criteria and this paper reports on a validation study.
Method This was a single blind, randomised (to practitioner and treatment sequence), cross-over pilot study and subjects were stratified for gender and joint type. Patients were drawn from the orthopaedic hip and knee, joint replacement waiting list. Intervention consisted of either 2 weeks of treatment with real acupuncture followed by 2 weeks on placebo, or vice versa. The prime outcome was a needle sensation questionnaire and there was a range of secondary outcomes.
Results 37 patients were randomised and completed treatment. Groups were well balanced at baseline. No significant differences between groups or needle type were found for any of the sensations measured. Most patients were unable to discriminate between the needles by penetration however nearly 40% were able to detect a difference in treatment type between needles.
Conclusion No major differences in outcome between real and placebo needling could be found. The fact that nearly 40% of subjects did not find that the two interventions were similar however, raises some serious concerns with regard to the wholesale adoption of this instrument as a standard acupuncture placebo. Further work on intertester reliability and standardisation of technique is highly recommended before we can be confident about using this needle in further studies.


(2)Hopwood V, Lewith GT, Prescott P. A single-blind, randomised, placebo controlled study of acupuncture for stroke. Journal of Neurology in press.

Objective To investigate the efficacy of acupuncture on stroke recovery compared to an inert placebo.
Design Placebo-controlled, randomised, clinical trial.
Setting Post-stroke rehabilitation wards in five NHS hospitals in the UK.
Subjects Patients between 4 and 10 days after their first stroke.
Interventions and outcome measures  The patients received 12 acupuncture or placebo treatments over four weeks,
Acupuncture with electrical stimulation was compared with mock TENS, and assessments continued for 12 months after entry. Primary outcome was the Barthel Index, (BI). Secondary outcomes were muscle power, Motricity Index (MI), mood, Nottingham Health Profile (NHP) and treatment credibility.
Results 92 patients completed data sets.  Data were analysed using both t tests and a structural equation based on longitudinal analysis of both BI and MI, using generalised estimating equations with an exchangeable correlation structure.
While both acupuncture and placebo (mock TENS) appeared to have had an equal effect on stroke recovery, there is no significant difference between the two interventions at 12 (p=0.737, 95% CI -2.00 to 2.81) and 52 weeks (p=0.371, 95% CI -3.48 to1.32).
An apparently accelerated improvement in the MI scores in the acupuncture group at 3 weeks, (p= 0.009, 95% CI 1.55 to 10.77), is interesting.

Conclusions Acupuncture did not demonstrate specific efficacy over placebo and both groups did as well as normally expected with this condition.

16). A randomised, controlled, single blind trial to evaluate the efficacy of a ‘Western Style’ acupuncture for chronic mechanical neck pain.

Investigators: Peter White, George Lewith

Funded by:  Smiths Charity £109,000

Status: Completed, 2 papers published

(1) White P, Lewith GT, Berman B, Birch S.  Reviews of acupuncture for chronic neck pain: pitfalls in conducting systematic reviews. Rheumatology. 2002; 41: 1224-1231.

This paper examines some of the problems specifically associated with conducting research into acupuncture and how this can lead to further problems with subsequent systematic reviews. Studies for the treatment of chronic neck pain have been used as examples of how presented information can be misleading to an acupuncture-naive reader and how researchers must be sensitive to these problems when compiling their inclusion and exclusion criteria. The problems associated with scoring trials are discussed and further work to increase the scope of scoring mechanisms is recommended in order to produce meaningful systematic reviews in the future.

17). Neuro-imaging the efficacy of acupuncture and placebo in pain.

Investigators: Peter White, George Lewith

Funded by:  Wellcome Imaging Unit £30,000

Status: Completed, paper published.

Pariente J, White P, Frackowiak RSJ, Lewith G.  Expectancy and belief modulate the neuronal substrates of pain treated by acupuncture.  NeuroImage. 2005; 25: 1161-1167.

Video: Brain scanning and Acupuncture


18). Evaluating the effectiveness of acupuncture in defined aspects of stroke recovery.

Investigators:  Val Hopwood and George Lewith

Funded by:  South & West Region (£173,000)

Status:  Study completed, 3 papers published.

(1)Hopwood V, Lewith GT, Prescott P. A single-blind, randomised, placebo controlled study of acupuncture for stroke. Journal of Neurology 255:858-866, 2008.

(2) Park J, Hopwood V, White AR, Ernst E.  Effectiveness of acupuncture for stroke: a systematic review.  J Neurol. 2001; 248: 558-563.


(3) Hopwood V, Lewith GT. Does acupuncture help stroke patients become more independent? J Alt Comp Med. 2005; 11 (1): 175-177.


19). A randomised controlled trial of acupuncture for the treatment of hyperventilation syndrome.

Funded by: University doctoral fellowship in conjunction with the NHS/Physiotherapy Research Foundation (£15,000).

Investigator: Denise Gibson

Supervisors: Peter White and Anne Bruton

Article In Press –
Gibson DH, Bruton A, Lewith GT, Mullee MThe effects of acupuncture as a  treatment for hyperventilation syndrome: a pilot randomised crossover trial.  (JACM).

REFERENCES TO ANECDOTAL RESEARCHES

https://hellogiggles.com/regular-acupuncture-treatments/

https://chinesemedicineworks.com/acupuncture-clinic/testimonials/

https://www.runnersworld.com/advanced/a20827470/acupuncture-reversing-the-stressful-effects-of-running/

https://forum.effectivealtruism.org/posts/7hAdT35KQqAsZZ8Km/my-journey-of-managing-stress-biohacking-with-ashwagandha

https://www.outlookindia.com/outlook-spotlight/19-ashwagandha-benefits-for-men-best-ashwagandha-withania-somnifera-pills-for-mens-health-testosterone-muscle-growth-natural-ksm-66-ashwagandha-supplements-estrogen-blockers-testo-boosters-news-261200

https://www.worldscientific.com/worldscibooks/10.1142/u032

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