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Karen J. Sherman – One of the best experts on this subject based on the ideXlab platform.

  • Do the effects of acupuncture vary between Acupuncturists? Analysis of the Acupuncture Trialists’ Collaboration individual patient data meta-analysis.
    Acupuncture in medicine : journal of the British Medical Acupuncture Society, 2020
    Co-Authors: Andrew J Vickers, George Lewith, Karen J. Sherman, Hugh Macpherson, Nadine E Foster, Claudia M Witt, Emily A Vertosick, Dominik Irnich, Klaus Linde

    Abstract:

    The degree to which the effects of acupuncture treatment vary between Acupuncturists is unknown. We used a large individual patient dataset of trials of acupuncture for chronic pain to assess practitioner heterogeneity.
    Individual patient data linked to identifiable Acupuncturists were drawn from a dataset of 39 high-quality trials of acupuncture, where the comparators were either sham acupuncture or non-acupuncture controls, such as standard care or waitlist. Heterogeneity among Acupuncturists was assessed by meta-analysis.
    A total of 1206 Acupuncturists in 13 trials were included. Statistically significant heterogeneity was found in trials with sham-control groups (p < 0.0001) and non-acupuncture control groups (p <0.0001). However, the degree of heterogeneity was very small, with the observed distribution of treatment effects virtually overlapping that expected by chance. For instance, for non-acupuncture-controlled trials, the proportion of Acupuncturists with effect sizes half a standard deviation greater or less than average was expected to be 34%, but was observed to be 37%. A limitation is that the trials included a relatively limited range of Acupuncturists, mainly physician-Acupuncturists.
    Although differences in effects between Acupuncturists were greater than expected by chance, the degree of variation was small. This suggests that most chronic pain patients in clinical practice would have similar results to those reported in high-quality trials; comparably, we did not find evidence to suggest that greater standardization of acupuncture practice would improve outcomes. Further research needs to be conducted exploring variability using a sample of Acupuncturists with a broader range of practice styles, training and experience.

  • The diagnosis and treatment of chronic back pain by Acupuncturists, chiropractors, and massage therapists.
    The Clinical journal of pain, 2006
    Co-Authors: Karen J. Sherman, Daniel C. Cherkin, Richard A. Deyo, Janet H. Erro, Andrea Hrbek, Roger B. Davis, David Eisenberg

    Abstract:

    Objectives: To describe the diagnostic and therapeutic content of visits for chronic back pain to Acupuncturists, chiropractors, and massage therapists. Methods: Randomly selected Acupuncturists, chiropractors, and massage therapists in two states were surveyed, and then eligible providers collected data on consecutive patient visits. The authors analyzed information on diagnosis, treatment, and self-care recommendations for chronic back pain patients collected during consecutive patient visits to these complementary and alternative medicine (CAM) providers. Results: Back pain was the most common reason for visits to each of these providers, with chronic back pain representing about 10% of visits to Acupuncturists, 20% of visits to chiropractors, and 12% of visits to massage therapists. Diagnosis by Acupuncturists included traditional questioning and inspecting the patient as well as pulse and tongue assessment and palpation of the acupuncture meridians. Treatments usually included acupuncture needling, heat of some sort, and other modalities, such as East Asian massage, herbs, and/or cupping (application of suction cups to the skin). Lifestyle recommendations were common, particularly exercise and dietary counseling. Visits to chiropractors usually included spinal and muscle/soft tissue examinations and spinal manipulation. Soft tissue techniques (eg, “active release”), stretch or strength training, and home exercise recommendations were much less common. Massage therapists usually performed a tissue assessment and commonly assessed range of motion. They emphasized Swedish, deep tissue, and trigger point massage techniques and usually made self-care recommendations, particularly increased water intake, hot/cold therapy, exercise, and body awareness. Conclusion: Information on the care patients routinely receive from CAM providers will help physicians better understand these increasingly popular forms of care.

  • The practice of acupuncture: Who are the providers and what do they do?
    Annals of family medicine, 2005
    Co-Authors: Karen J. Sherman, Daniel C. Cherkin, David Eisenberg, Janet H. Erro, Andrea Hrbek, Richard A. Deyo

    Abstract:

    PURPOSE This study provides basic information about the training and practices of licensed Acupuncturists. METHODS Randomly selected licensed Acupuncturists in Massachusetts and Wash- ington state were interviewed and asked to record information on 20 consecutive patient visits. RESULTS Most Acupuncturists in both states had 3 or 4 years of academic acu- puncture training and had received additional “postgraduate” training as well. Acupuncturists treated a wide range of conditions, including musculoskeletal problems (usually back, neck, and shoulder) (33% in Massachusetts and 47% in Washington), general body symptoms (12% and 9%, respectively) such as fatigue, neurological problems (10% and 12%, respectively) (eg, headaches), and psy- chological complaints (10% and 8%, respectively) (especially anxiety and depres- sion). Traditional Chinese medicine (TCM) was the predominant style of acupunc- ture used in both states (79% and 86%, respectively). Most visits included a tra- ditional diagnostic assessment (more than 99%), regular body acupuncture (95% and 93%, respectively), and additional treatment modalities (79% and 77%, respectively). These included heat and lifestyle advice (66% and 65%, respec- tively), most commonly dietary advice and exercise recommendations. Chinese herbs were used in about one third of visits. Although most patients self-referred to acupuncture, about one half received concomitant care from a physician. Acu- puncturists rarely communicated with the physicians of their patients who were providing care for the same problem. CONCLUSIONS This study contributes new information about Acupuncturists and the care they provide that should be useful to clinicians interested in becoming more knowledgeable about complementary or alternative medical therapies avail- able to their patients.

Daniel C. Cherkin – One of the best experts on this subject based on the ideXlab platform.

  • The diagnosis and treatment of chronic back pain by Acupuncturists, chiropractors, and massage therapists.
    The Clinical journal of pain, 2006
    Co-Authors: Karen J. Sherman, Daniel C. Cherkin, Richard A. Deyo, Janet H. Erro, Andrea Hrbek, Roger B. Davis, David Eisenberg

    Abstract:

    Objectives: To describe the diagnostic and therapeutic content of visits for chronic back pain to Acupuncturists, chiropractors, and massage therapists. Methods: Randomly selected Acupuncturists, chiropractors, and massage therapists in two states were surveyed, and then eligible providers collected data on consecutive patient visits. The authors analyzed information on diagnosis, treatment, and self-care recommendations for chronic back pain patients collected during consecutive patient visits to these complementary and alternative medicine (CAM) providers. Results: Back pain was the most common reason for visits to each of these providers, with chronic back pain representing about 10% of visits to Acupuncturists, 20% of visits to chiropractors, and 12% of visits to massage therapists. Diagnosis by Acupuncturists included traditional questioning and inspecting the patient as well as pulse and tongue assessment and palpation of the acupuncture meridians. Treatments usually included acupuncture needling, heat of some sort, and other modalities, such as East Asian massage, herbs, and/or cupping (application of suction cups to the skin). Lifestyle recommendations were common, particularly exercise and dietary counseling. Visits to chiropractors usually included spinal and muscle/soft tissue examinations and spinal manipulation. Soft tissue techniques (eg, “active release”), stretch or strength training, and home exercise recommendations were much less common. Massage therapists usually performed a tissue assessment and commonly assessed range of motion. They emphasized Swedish, deep tissue, and trigger point massage techniques and usually made self-care recommendations, particularly increased water intake, hot/cold therapy, exercise, and body awareness. Conclusion: Information on the care patients routinely receive from CAM providers will help physicians better understand these increasingly popular forms of care.

  • The practice of acupuncture: Who are the providers and what do they do?
    Annals of family medicine, 2005
    Co-Authors: Karen J. Sherman, Daniel C. Cherkin, David Eisenberg, Janet H. Erro, Andrea Hrbek, Richard A. Deyo

    Abstract:

    PURPOSE This study provides basic information about the training and practices of licensed Acupuncturists. METHODS Randomly selected licensed Acupuncturists in Massachusetts and Wash- ington state were interviewed and asked to record information on 20 consecutive patient visits. RESULTS Most Acupuncturists in both states had 3 or 4 years of academic acu- puncture training and had received additional “postgraduate” training as well. Acupuncturists treated a wide range of conditions, including musculoskeletal problems (usually back, neck, and shoulder) (33% in Massachusetts and 47% in Washington), general body symptoms (12% and 9%, respectively) such as fatigue, neurological problems (10% and 12%, respectively) (eg, headaches), and psy- chological complaints (10% and 8%, respectively) (especially anxiety and depres- sion). Traditional Chinese medicine (TCM) was the predominant style of acupunc- ture used in both states (79% and 86%, respectively). Most visits included a tra- ditional diagnostic assessment (more than 99%), regular body acupuncture (95% and 93%, respectively), and additional treatment modalities (79% and 77%, respectively). These included heat and lifestyle advice (66% and 65%, respec- tively), most commonly dietary advice and exercise recommendations. Chinese herbs were used in about one third of visits. Although most patients self-referred to acupuncture, about one half received concomitant care from a physician. Acu- puncturists rarely communicated with the physicians of their patients who were providing care for the same problem. CONCLUSIONS This study contributes new information about Acupuncturists and the care they provide that should be useful to clinicians interested in becoming more knowledgeable about complementary or alternative medical therapies avail- able to their patients.

  • A comparison of physician and nonphysician acupuncture treatment for chronic low back pain.
    The Clinical journal of pain, 2005
    Co-Authors: Donna Kalauokalani, Daniel C. Cherkin, Karen J. Sherman

    Abstract:

    Background Although up to a third of the 10,000 Acupuncturists in the United States are medical doctors, little is known about the acupuncture techniques they use or how their practices compare with those of nonphysician licensed Acupuncturists. This is the first study providing descriptive data on physician acupuncture and comparison to nonphysician acupuncture. Purpose This study describes how a random sample of physician Acupuncturists in the United States diagnose and treat chronic low back pain and contrasts their practices with those of nonphysician licensed Acupuncturists. Methods A total of 464 questionnaires were mailed to physician Acupuncturists randomly sampled from 3 sources: web-based Yellow Pages, American Academy of Medical Acupuncturists (AAMA) membership, and Pain Clinics associated with American College of Graduate Medical Education-approved fellowship programs. Responses (n=137, 30%) were analyzed using descriptive statistics. The results of this survey were compared with data published from a similar survey of nonphysician licensed Acupuncturists in Washington State. Results Physicians who perform acupuncture use a mixture of styles and emphasize neuroanatomic approaches to needle placement. Most physicians received training in French Energetic acupuncture. In contrast, most nonphysician licensed Acupuncturists use a traditional Chinese medicine approach to needle placement. Despite this apparent difference in their predominant styles of acupuncture, there was a high correlation between physician and nonphysician licensed Acupuncturist acupoint selection to treat low back pain. In addition to acupuncture needling, physicians use other medical treatments, whereas nonphysician licensed Acupuncturists’ employ a variety of traditional Chinese medicine adjuncts to needling. Conclusion This study provides new information about the nature of physician acupuncture practice in the United States and how it compares to acupuncture provided by nonphysician licensed Acupuncturists. Further research is necessary to determine if the different types of acupuncture provided by physicians and nonphysician Acupuncturists affect treatment outcomes and costs for patients with chronic low back pain.

Helene M. Langevin – One of the best experts on this subject based on the ideXlab platform.

  • Yin scores and yang scores: A new method for quantitative diagnostic evaluation in traditional Chinese medicine research.
    Journal of alternative and complementary medicine (New York N.Y.), 2004
    Co-Authors: Helene M. Langevin, Karen J. Sherman, Gary J. Badger, Bonnie K. Povolny, Robert T Davis, Alexander C. Johnston, Janet Kahn, Ted J. Kaptchuk

    Abstract:

    Objective: To develop and evaluate a method for quantitative evaluation of yin and yang (yin and yang scores) in human subjects for the purposes of research. This method aims to classify subjects into groups allowing future quantitative testing of key research questions such as: do different groups of patients respond differently to acupuncture treatments or Chinese herb formulas? Methods: In a pilot study of inter-rater reliability, 12 volunteers were each successively interviewed and examined by 6 Acupuncturists on the same day. Each Acupuncturist gave each volunteer a score for yin and a score for yang on a scale of -10 to +10, zero representing a “balanced” score. Acupuncturists were blinded to each other’s scores. Results: Overall mean (±standard deviation [SD]) yin and yang scores were -1.86 ± 0.90 and -0.68 ± 1.23 respectively. Intraclass correlations (ICCs) associated with a single Acupuncturist‘s ratings were 0.35 (yin) and 0.36 (yang). ICC’s for subject’s mean scores based on the six acupuncturi…

  • mechanical signaling through connective tissue a mechanism for the therapeutic effect of acupuncture
    The FASEB Journal, 2001
    Co-Authors: Helene M. Langevin, David L Churchill, Marilyn J Cipolla

    Abstract:

    The mechanism of action of acupuncture remains largely unknown. The reaction to acupuncture needling known as ‘de qi’, widely viewed as essential to the therapeutic effect of acupuncture, may be a key to understanding its mechanism of action. De qi includes a characteristic needling sensation, perceived by the patient, and ‘needle grasp’ perceived by the Acupuncturist. During needle grasp, the Acupuncturist feels pulling and increased resistance to further movement of the inserted needle. We hypothesize that 1) needle grasp is due to mechanical coupling between the needle and connective tissue with winding of tissue around the needle during needle rotation and 2) needle manipulation transmits a mechanical signal to connective tissue cells via mechanotransduction. Such a mechanism may explain local and remote, as well as long-term effects of acupuncture.

  • mechanical signaling through connective tissue a mechanism for the therapeutic effect of acupuncture
    The FASEB Journal, 2001
    Co-Authors: Helene M. Langevin, David L Churchill, Marilyn J Cipolla

    Abstract:

    The mechanism of action of acupuncture remains largely unknown. The reaction to acupuncture needling known as ‘de qi’, widely viewed as essential to the therapeutic effect of acupuncture, may be a key to understanding its mechanism of action. De qi includes a characteristic needling sensation, perceived by the patient, and ‘needle grasp’ perceived by the Acupuncturist. During needle grasp, the Acupuncturist feels pulling and increased resistance to further movement of the inserted needle. We hypothesize that 1) needle grasp is due to mechanical coupling between the needle and connective tissue with winding of tissue around the needle during needle rotation and 2) needle manipulation transmits a mechanical signal to connective tissue cells via mechanotransduction. Such a mechanism may explain local and remote, as well as long-term effects of acupuncture.—Langevin, H. M., Churchill, D. L., Cipolla, M. J. Mechanical signaling through connective tissue: a mechanism for the therapeutic effect of acupuncture.