By Elizabeth Sommers, PhD, MPH, LAc and Kristen E. Porter, PhD, MS, MAc, LAc
Acupuncture and Traditional Chinese Medicine were well-represented at the International Research Congress on Integrative Medicine and Health (IRCIMH)- 2014 which took place in Miami from May 13–16.
More than 700 registrants from 22 countries attended and represented a spectrum of complementary and integrative approaches, including acupuncture, chiropractic and naturopathic medicine, massage and herbalism.
More than 100 of the presentations were about Traditional Chinese Medicine, most of which were focused on acupuncture. Numerous presenters echoed the current critiques of sham-based randomized clinical trials. Evidence about the active effects of so-called sham procedures continues to mount, clearly indicating that "sham" effects are not inert. For acupuncture researchers, being able to refine our methods of study design is critical. Although the "gold standard" randomized clinical trial in acupuncture was originally considered to include some type of "sham" comparison, colleagues in physiology and brain imaging have provided us with evidence about sham acupuncture's inadequacy as a comparison intervention.1
The congress was convened by the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) and also served as the Ninth International Congress on Complementary Medicine Research sponsored by the International Society for Complementary Medicine Research (ISCMR). An impressive array of 65 oral and 320 poster presentations examined topics covering a comprehensive overview of all aspects of integrative medicine and health care: basic science, clinical research, education of providers, health services research, and research methodology.
In his talk entitled "Assessing the Value for Money of Acupuncture for Chronic Pain in the UK: Many Challenges and Some Solutions" Andrea Manca PhD MSC. discussed some of the universal problems of doing health-related research. Common to research in biomedicine as well as in integrative approaches, investigators face the challenges of missing data and determining how to best measure and assess outcomes. Instead of a simplistic outcome such as "acupuncture works or doesn't work," integrating health services research approaches allows us to include outcome measures such as quality of life, physical and mental health parameters, and patients' ability to engage in activities of daily living. These dimensions more fully describe the changes and benefits related to acupuncture treatment.
Further refining the research about the effects of acupuncture, George Lewith MD presented Characteristics of Acupuncture Treatment Associated with Outcome: Analyses of 17,922 Patients with Chronic Pain in Randomized Controlled Trials. He and his colleagues conducted systematic reviews of studies in the area of chronic pain of the neck, back, shoulder, or headache. Collectively, these studies demonstrated approximately a 33 percent decrease in pain and 50 percent decrease in use of analgesics by participants receiving acupuncture compared with those receiving sham treatment. Factors which seemed to influence the clinical outcomes included the number of points used, and the number and duration of the treatment session. In general, Lewith and his colleagues found that a "higher dose" of acupuncture contributed to better outcomes. "Higher dose" depended on the number of points used, duration of each session, and the number of sessions.
Lewith also hypothesized that there may be different physiological mechanisms related to the type of condition being treated. He identified three major types of acupuncture: (1) related to addiction – whose mechanisms may be endorphin-based; (2) pain management and (3) all other imbalances. He speculated that because of these different mechanisms, specific trial designs may be different for each type of situation.
Maria Chao PhD, Larissa Duncan PhD, Kimberly Tippens ND MSAOM MPH, Paula Gardiner MD MPH, Danielle Dresner MPH and Katherine Gergen-Barnett MD presented a panel discussion entitled Methodological Innovation in Integrative Medicine Research Targeting Health Disparities. Acupuncture represented a significant part of this session. Dr. Tippens described community-based acupuncture programming, which is based on the social justice model to improve access to care. Community acupuncture refers to models that incorporate group treatment setting with associated lower cost for clients. She concluded that community acupuncture "fills a gap for the uninsured, under-insured and medically under-served population in Portland, Oregon." Three of the panelists (Gardiner, Dresner and Gergen-Barnett) represented Boston Medical Center's program on Integrative Medicine, which is housed in the Department of Family Medicine. Acupuncture, as well as massage and yoga, are utilized in a number of clinics throughout the hospital.
The acceptance of acupuncture as a valid and effective approach to treatment also continues to grow in the U.S. military. Lisa Conboy MA MS ScD, Director of Research at the New England School of Acupuncture, presented Management of Gulf War Syndrome Symptoms with Acupuncture: Findings of a Wait-List Controlled RCT. Symptoms experienced by veterans who were involved in the 1990-1991 Gulf War include fatigue, mood and cognitive disorders, and musculoskeletal problems. These symptoms, associated with a number of chemical exposures, seem to be more severe for those who served as ground troops. The study offered individualized acupuncture treatment for six months on either a once-per-week or twice-per-week basis. Approximately 117 veterans participated in the study. Pain relief was noted immediately and other symptoms responded favorably as well.
Overall, IRCIMH proved to be a considerable success in networking and uniting researchers from a variety of fields. The future of acupuncture research seems to be trans-disciplinary, comprehensive, and firmly connected to social justice.
Longhurst J. Acupuncture cardiovascular effects: A mechanistic perspective. Medical Acupuncture 2013 April 25(2):101.113.
Author Note: The next IRCIMH will be held in Las Vegas NV at the Green Valley Ranch Resort on May 17-20 2016. In partnership with the conference, the Journal of Alternative and Complementary Medicine published all accepted abstracts. Abstracts of all the conference presentations can be accessed at: http://online.liebertpub.com/toc/acm/20/5.
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