| 1. |
- Chae, Younbyoung, et al.
(författare)
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The role of touch in acupuncture treatment
- 2017
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Ingår i: Acupuncture in Medicine. - : BMJ PUBLISHING GROUP. - 0964-5284 .- 1759-9873. ; 35:2, s. 148-152
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Forskningsöversikt (refereegranskat)abstract
- Acupuncture is a therapeutic treatment that is characterised by the insertion of a needle at a particular location on the body. Acupuncture stimulation includes sensory-discriminative and affective-social touch dimensions. In this review, we discuss the role of touch during acupuncture stimulation with an emphasis on the therapeutic, sensory-discriminative and affective-social aspects. In the discriminative dimension, de qi, which is associated with needling, includes a combination of various sensations, such as heaviness, numbness, soreness and distension. Achieving the appropriate de qi sensation appears to be fundamental to the therapeutic outcome following acupuncture treatment. In the affective dimension, the acupuncture procedure typically includes gentle manual touch stimulation, which induces feelings of calm and well-being, perhaps by activating C tactile fibres. Enhanced activity of C tactile afferents may induce a limbic touch response, resulting in emotional and hormonal reactions. Because acupuncture is a therapist intensive and complex intervention, it is necessary to understand the role of social touch between the practitioner and patient. Both sensory-discriminative and affective-social touch aspects play an important role in the therapeutic effect of acupuncture treatment in clinical practice.
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| 2. |
- Enblom, Anna
(författare)
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Patients and physiotherapists belief in and use of acupuncture for cancer-related symptoms
- 2017
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Ingår i: Acupuncture in Medicine. - : BMJ PUBLISHING GROUP. - 0964-5284 .- 1759-9873. ; 35:4, s. 251-258
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Tidskriftsartikel (refereegranskat)abstract
- Background It is important to investigate attitudes to acupuncture, because therapists and patients expectations may affect the treatment outcome. Aim To explore the use of and belief in acupuncture among oncological physiotherapists and to explore patients interest in receiving acupuncture during cancer therapy and their belief in its effectiveness. Methods 522 patients (80% female, mean age 67 years) reported on their interest in receiving acupuncture for nausea during radiotherapy treatment; a subgroup (n=198) additionally disclosed their belief in the effectiveness of acupuncture. 117 Swedish oncological physiotherapists (96% female, mean age 48 years) answered a questionnaire regarding their use of and belief in acupuncture. Results Of the patients initiating cancer therapy, 359 (69%) were interested in receiving acupuncture. The patients believed acupuncture to be effective for pain (79%), nausea (79%) and vasomotor symptoms (48%). Of the 117 physiotherapists, 66 (56%) practised acupuncture. Physiotherapists generally believed in the effectiveness of acupuncture. For pain, 89% believed that acupuncture was effective and 42% of them practised it. Similar responses were noted for chemotherapy-induced nausea (86% and 38%, respectively) and vasomotor symptoms (80% and 28%, respectively). Younger physiotherapists and patients were more likely to believe in the effectiveness of acupuncture compared with older ones. Conclusions More than two thirds of patients with cancer were interested in receiving acupuncture during therapy. Patients and oncological physiotherapists believed that acupuncture was effective for cancer pain, nausea and vasomotor symptoms. Further studies of acupuncture for cancer-related symptoms and of the effect of patients and clinicians therapeutic relationships, including treatment expectations, would be welcome.
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| 3. |
- Enblom, Anna, et al.
(författare)
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Pilot testing of methods for evaluation of acupuncture for emesis during radiotherapy: a randomised single subject experimental design
- 2011
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Ingår i: ACUPUNCTURE IN MEDICINE. - : The British Medical Acupuncture Society. - 0964-5284 .- 1759-9873. ; 29:2, s. 94-102
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Tidskriftsartikel (refereegranskat)abstract
- Background Many acupuncture studies are of weak methodological quality, possibly due to lack of pilot testing. This pilot study tested design features, including test of feasibility, compliance to treatment and data collection, level of blinding success and the patients potential perceived effects of the treatment, in preparation for an efficacy study. Method A modified single subject experimental design was conducted. 10 cancer patients were randomised to verum penetrating acupuncture or non-penetrating sham needles for 30 min 2-3 times/week during radiotherapy over abdomen/pelvis. They answered test-retested emesis questions (r=0.527-1.0) covering nausea, vomiting, use of antiemetics, wellbeing and activities of daily living. Results Overall, the patients completed 98% of the 345 emesis-questionnaire days and 101 of the 115 offered treatments. All patients believed they received verum acupuncture. 10 patients experienced antiemetic effects, seven relaxation, five pain-reduction and five experienced sleep improvement. Two types of nausea questions showed absolute concordance (r=1.0) (n of observations=456). Nausea was experienced by one of five verum acupuncture treated patients (duration median 0% of the radiotherapy-days) and four of five sham acupuncture treated patients (duration median 24% of the radiotherapy-days). Patients experiencing nausea rated decreased wellbeing and performance of daily activities compared to patients free from nausea. Conclusions All patients were blinded, complied with verum/sham treatments and data-collection, and believed they had effects of the received treatment. The methods for verum/sham treatment and data collection may thus be used in an adequately powered randomised controlled study of the effect of acupuncture for radiotherapy-induced emesis.
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| 4. |
- Enblom, Anna, et al.
(författare)
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Type and frequency of side effects during PC6 acupuncture : observations from therapists and patients participating in clinical efficacy trials of acupuncture
- 2017
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Ingår i: Acupuncture in Medicine. - : SAGE Publications. - 1759-9873 .- 0964-5284. ; 35:6, s. 421-429
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Many therapists practise PC6 acupuncture for emesis (nausea and vomiting) during pregnancy, different cancer therapies, palliative care, after surgery, or to induce relaxing effects in general. Knowledge of side effects is central to shared decision-making.AIM: To describe the type and frequency of side effects and the level of needle-induced pain during PC6 acupuncture.METHODS: We included 1298 PC6 acupuncture treatments, delivered to 221 participants (77% women, mean age 52.5, range 18-91 years). The subjects had received genuine PC6 acupuncture, in one of two previous randomised controlled trials, aimed at inducing antiemetic (n=100, with 100 providing data on side effects and 94 on needle-induced pain, respectively) or relaxing (n=121, with 120 providing data) effects. Side effects during and after the acupuncture treatments were registered in structured treatment protocols and study diaries.RESULTS: No serious complications occurred. Side effects during the acupuncture sessions included minor bleeding in 5.0%, tiredness in 4.9%, numbness in 4.5% and dizziness in 1.4% of the 1298 treatments. After treatment, the mean proportions of participants reporting side effects each week were: tiredness 25.8%; feeling cold 17.8%; dizziness 9.7%; sweating 9.3%; haematoma 8.8%; and soreness at the needling sites 4.3%. Participants perceived the needling to be not painful (47.4% of participants), or mildly (39.1%), moderately (11.6%) or very painful (1.4%).CONCLUSIONS: Few side effects occurred and those that did were mild. Nearly 90% found PC6 acupuncture to be not painful or only mildly painful. Healthcare professionals may consider the observed levels of side effects when informing patients about side effects of PC6 acupuncture.
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| 5. |
- Hansson, Y, et al.
(författare)
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Intramuscular and periosteal acupuncture in patients suffering from chronic musculoskeletal pain - a controlled trial
- 2008
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Ingår i: Acupuncture in medicine : journal of the British Medical Acupuncture Society. - : SAGE Publications. - 0964-5284. ; 26:4, s. 214-223
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Tidskriftsartikel (refereegranskat)abstract
- Periosteal acupuncture has shown promising results in clinical practice. The aim was to compare three patient groups: one with intramuscular acupuncture, one with periosteal acupuncture, and a third information control group, with respect to clinically relevant pain relief, physical functioning and intake of analgesics in patients with chronic musculoskeletal pain in the neck or low back or both. We reported the psychological changes in these patients in a previous issue of this journal. Methods 144 consecutive patients with nociceptive pain for >3 months, aged 18–70 years were alternately allocated to: intramuscular acupuncture (n=59); periosteal acupuncture (n=55); or control group with information only (n=30). All patients were encouraged to stay active. Acupuncture was administered with eight treatments during five weeks, and two optional additional treatments after one month. Pain was estimated with a daily VAS in a pain diary and with an average weekly pain score. Clinically relevant pain relief was defined as at least a 30% decrease from the initial value. Physical functioning was evaluated with Disability Rating Index. All estimations were performed prior to treatment, one week after, and one, three and six months after treatment. Results There were no differences between the effects of the two acupuncture methods. There were differences between each of the two acupuncture groups compared with the control group on all test occasions up to one month after treatment with respect to the pain diary and one week after treatment with respect to pain last week (P<0.05). Pain relief as measured by a pain diary was obtained in 29 patients in the intramuscular acupuncture group, 25 in the periosteal acupuncture group, and 5 patients in the control group. Six months after treatment, 46% of the intramuscular acupuncture patients and 45% of the periosteal acupuncture patients had obtained pain relief in terms of the pain diary. The corresponding figure for pain last week was 29% in each group. Conclusion Periosteal pecking was no more effective than standard intramuscular acupuncture, but both were more effective than information only.
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| 6. |
- Landgren, Kajsa, et al.
(författare)
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Acupuncture reduces crying in infants with infantile colic: a randomised, controlled, blind clinical study.
- 2010
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Ingår i: Acupuncture in Medicine. - : SAGE Publications. - 1759-9873 .- 0964-5284. ; 28, s. 174-179
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate whether acupuncture reduces the duration and intensity of crying in infants with colic. Patients and methods 90 otherwise healthy infants, 2-8 weeks old, with infantile colic were randomised in this controlled blind study. 81 completed a structured programme consisting of six visits during 3 weeks to an acupuncture clinic in Sweden. Parents blinded to the allocation of their children met a blinded nurse. The infant was subsequently given to another nurse in a separate room, who handled all infants similarly except that infants allocated to receive acupuncture were given minimal, standardised acupuncture for 2 s in LI4. RESULTS: There was a difference (p=0.034) favouring the acupuncture group in the time which passed from inclusion until the infant no longer met the criteria for colic. The duration of fussing was lower in the acupuncture group the first (74 vs 129 min; p=0.029) and second week (71 vs 102 min; p=0.047) as well as the duration of colicky crying in the second intervention week (9 vs 13 min; p=0.046) was lower in the acupuncture group. The total duration of fussing, crying and colicky crying (TC) was lower in the acupuncture group during the first (193 vs 225 min; p=0.025) and the second intervention week (164 vs 188 min; p=0.016). The relative difference from baseline throughout the intervention weeks showed differences between groups for fussing in the first week (22 vs 6 min; p=0.028), for colicky crying in the second week (92 vs 73 min; p=0.041) and for TC in the second week (44 vs 29 min; p=0.024), demonstrating favour towards the acupuncture group. CONCLUSIONS: Minimal acupuncture shortened the duration and reduced the intensity of crying in infants with colic. Further research using different acupuncture points, needle techniques and intervals between treatments is required.
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| 7. |
- Landgren, Kajsa
(författare)
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Ear acupuncture as an adjunct in a treatment protocol for anorexia nervosa : utilization rate and nurses’ experience
- 2022
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Ingår i: Acupuncture in Medicine. - : SAGE Publications. - 0964-5284 .- 1759-9873. ; 40:4, s. 322-332
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Tidskriftsartikel (refereegranskat)abstract
- Background: Anorexia nervosa (AN) is a life-threatening illness. Sometimes long inpatient treatment is necessary, increasing the anxiety that comes with hospitalization and the necessary weight gain. Safe, non-pharmacological adjunctive therapies that improve subjective health are called for. Objective: The aim of this non-randomized, mixed-methods observational study was to describe the utilization rate and nurses’ experiences of ear acupuncture in a highly specialized clinic for eating disorders in Sweden, in which acupuncture had been implemented as part of routine clinical care. Twenty-five patients with AN-treated voluntarily or by law were included. The semi-standardized National Acupuncture Detoxification Association (NADA) ear acupuncture protocol, sometimes combined with needling at 2 traditional acupuncture point locations on the body, had been implemented as a voluntary adjunct to usual care, twice weekly. To evaluate the acceptance of acupuncture, the study examined how often patients chose acupuncture when offered on schedule, and how often they asked for extra acupuncture sessions. Patients rated their subjective health using the hospital anxiety and depression scale (HADS) and visual analogue scale (VAS), treatment satisfaction with usual care and acupuncture, and health-related quality of life with the RAND36 instrument. A credibility/expectancy questionnaire (CEQ) was used to measure confidence in treatment. Body mass index (BMI) was calculated to follow the patients’ recovery. Nurses’ experiences of giving acupuncture as a part of routine care were captured in interviews, and analysed with content analysis. Ethical approval was obtained. Results: Despite an initially moderate level of trust in acupuncture, the utilization rate of the scheduled acupuncture was 89% and patients asked for extra acupuncture sessions on 28 occasions. No serious side effects were reported. Nurses’ experiences of providing acupuncture were positive. They were generally enthusiastic, although they reported finding it difficult to organize group treatments and to find time for acupuncture sessions if they were not scheduled. Conclusion: Further research into the effectiveness and costs of acupuncture in psychiatric care is needed. This study provides relevant information for clinicians as well as researchers planning future randomized controlled trials.
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| 8. |
- Landgren, Kajsa, et al.
(författare)
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Effect of minimal acupuncture for infantile colic : A multicentre, three-armed, single-blind, randomised controlled trial (ACU-COL)
- 2017
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Ingår i: Acupuncture in Medicine. - : SAGE Publications. - 0964-5284 .- 1759-9873. ; 35, s. 171-179
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Tidskriftsartikel (refereegranskat)abstract
- Background Evidence for treating infantile colic with acupuncture is contradictory. Aim To evaluate and compare the effect of two types of acupuncture versus no acupuncture in infants with colic in public child health centres (CHCs). Methods A multicentre, randomised controlled, single-blind, three-armed trial (ACU-COL) comparing two styles of acupuncture with no acupuncture, as an adjunct to standard care, was conducted. Among 426 infants whose parents sought help for colic and registered their child's fussing/crying in a diary, 157 fulfilled the criteria for colic and 147 started the intervention. All infants received usual care plus four extra visits to CHCs with advice/support (twice a week for 2 weeks), comprising gold standard care. The infants were randomly allocated to three groups: (A) standardised minimal acupuncture at LI4; (B) semistandardised individual acupuncture inspired by Traditional Chinese Medicine; and (C) no acupuncture. The CHC nurses and parents were blinded. Acupuncture was given by nurses with extensive experience of acupuncture. Results The effect of the two types of acupuncture was similar and both were superior to gold standard care alone. Relative to baseline, there was a greater relative reduction in time spent crying and colicky crying by the second intervention week (p=0.050) and follow-up period (p=0.031), respectively, in infants receiving either type of acupuncture. More infants receiving acupuncture cried <3 hours/day, and thereby no longer fulfilled criteria for colic, in the first (p=0.040) and second (p=0.006) intervention weeks. No serious adverse events were reported. Conclusions Acupuncture appears to reduce crying in infants with colic safely.
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| 9. |
- Landgren, Kajsa, et al.
(författare)
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The effect of two types of minimal acupuncture on stooling, sleeping and feeding in infants with colic : secondary analysis of a multicentre RCT in Sweden (ACU-COL)
- 2021
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Ingår i: Acupuncture in Medicine. - : SAGE Publications. - 0964-5284 .- 1759-9873. ; 39:2, s. 106-115
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Tidskriftsartikel (refereegranskat)abstract
- Background: Evidence for the effect of minimal acupuncture in infants with colic is limited. Aim: To compare the effect of standardized minimal acupuncture, individualized acupuncture (where traditional acupuncture points were chosen according to the infant’s symptoms) and no acupuncture on objective measures of stooling, feeding and sleeping in infants with colic (based on diaries) and perceived changes in these parameters (based on parental questionnaires). Methods: This was a secondary analysis of a multicentre randomized controlled three-armed trial conducted in four counties in Sweden between January 2013 and May 2015 (ACU-COL). The effect on crying has already been published and showed a decrease in crying time for the acupuncture groups. Infants, 2–8 weeks old, who cried and fussed for more than 3 h/day for more than 3 days/week, and thereby fulfilled the criteria for infantile colic, received four extra visits to their ordinary child health centre. The infants (n = 147) were randomly allocated via a computer-generated list to standardized minimal acupuncture at LI4 for 5 s (group A, n = 48), semi-standardized individual acupuncture with a maximum of five insertions for up to 30 s (group B, n = 49), or no acupuncture (group C, n = 48). The parents and the ordinary staff were blinded. Data were collected using: (1) diaries at baseline, during the two intervention weeks and 1-week follow-up; and (2) questionnaires with quantitative and qualitative components used at the second and fourth visits and during a follow-up telephone call. Outcomes were the changes in frequency of stooling and in hours of sleep per day. Results: There were no differences between groups for stooling, feeding, or sleeping at any time point according to data from the diaries. At the follow-up phone call, more parents in groups A and B (compared to group C) perceived that feeding and sleep had changed and that the symptoms of colic had improved.
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| 10. |
- Li, J, et al.
(författare)
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A prospective pilot study of the effect of acupuncture on insulin sensitivity in women with polycystic ovary syndrome and insulin resistance
- 2020
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Ingår i: Acupuncture in medicine : journal of the British Medical Acupuncture Society. - : SAGE Publications. - 1759-9873. ; 38:5, s. 310-318
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Tidskriftsartikel (refereegranskat)abstract
- To test the hypothesis that acupuncture improves insulin sensitivity in women with polycystic ovary syndrome (PCOS) and insulin resistance (IR). Design: Prospective pilot study. Setting: Guangzhou, China, 2014–2016. Participants: Eighty women with PCOS aged 18–40 years with body mass index (BMI) above 18.5 kg/m2 and with homeostatic model assessment for insulin resistance (HOMA-IR) index ⩾2.14. Interventions: Subjects received acupuncture with combined manual and low-frequency electrical stimulation of the needles three times per week for 6 months. Primary and secondary outcome measures: The primary outcome was the change in HOMA-IR after 6 months of acupuncture relative to baseline. Secondary outcomes included changes after 6 months of acupuncture and at 3 months of follow-up (both relative to baseline) in oral glucose tolerance test (OGTT) parameters (glucose and insulin levels), anthropometric measurements, and circulating metabolic and endocrine variables. Results: HOMA-IR and fasting plasma glucose and insulin levels were significantly decreased after 6 months of acupuncture, and both HOMA-IR and fasting insulin remained significantly decreased at 3 months of follow-up. In a subgroup analysis of normal-weight and overweight/obese women, HOMA-IR was reduced after 6 months of acupuncture in both subgroups, but there was no significant difference between the two groups. Conclusions: Acupuncture treatment in Chinese women with PCOS and IR was associated with an encouraging improvement in insulin sensitivity. Further randomized controlled studies are required to confirm the efficacy of acupuncture for this indication.
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| 11. |
- Lund, I, et al.
(författare)
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Are minimal, superficial or sham acupuncture procedures acceptable as inert placebo controls?
- 2006
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Ingår i: Acupuncture in medicine : journal of the British Medical Acupuncture Society. - : SAGE Publications. - 0964-5284. ; 24:1, s. 13-5
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Tidskriftsartikel (refereegranskat)abstract
- Most controlled trials of acupuncture have used minimal, superficial, sham, or ‘placebo’ acupuncture. It has recently been demonstrated that light touch of the skin stimulates mechanoreceptors coupled to slow conducting unmyelinated (C) afferents resulting in activity in the insular region, but not in the somatosensory cortex. Activity in these C tactile afferents has been suggested to induce a ‘limbic touch’ response resulting in emotional and hormonal reactions. It is likely that, in many acupuncture studies, control procedures that are meant to be inert are in fact activating these C tactile afferents and consequently result in the alleviation of the affective component of pain. This could explain why control interventions are equally effective as acupuncture in alleviating pain conditions that are predominantly associated with affective components such as migraine or low back pain, but not those with a more pronounced sensory component, such as osteoarthritis of the knee or lateral epicondylalgia.
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| 12. |
- Lund, I, et al.
(författare)
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Aspects of pain, its assessment and evaluation from an acupuncture perspective
- 2006
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Ingår i: Acupuncture in medicine : journal of the British Medical Acupuncture Society. - : SAGE Publications. - 0964-5284. ; 24:3, s. 109-17
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Tidskriftsartikel (refereegranskat)abstract
- Pain is a major clinical problem that causes great suffering for the individual and incurs costs for society. Accurate assessment and evaluation of perceived pain is necessary for diagnosis, for choice of treatment, and for the evaluation of treatment efficacy. The assessment of an individual's pain is a challenge since pain is a subjective, multidimensional experience, and assessment is based on the person's own self-report. The results are often varied, possibly due to inter-individual variation, but also in relation to gender and aetiology. A gold standard for pain assessment is still lacking, but rating scales, questionnaires, and methods derived from psychophysical concepts, such as threshold assessments and perceptual matching, are used. In the evaluation of pain and associated variables, both systematic and individual variation should be taken into account, as should pain-associated symptoms. Recommendations for pain treatment should be based on the patient's specific needs. Therefore, it is important to assess the level of perceived pain taking individual variation into account. The methods used should preferably have proved to be useful in randomised controlled trials, and analysis of pain assessment should consider its non-metric properties. In the future, the use of studies with a naturalistic protocol together with individual assessment of individual pain responses could increase the internal and external validity.
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| 13. |
- Lund, I, et al.
(författare)
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Is it all about sex? Acupuncture for the treatment of pain from a biological and gender perspective
- 2008
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Ingår i: Acupuncture in medicine : journal of the British Medical Acupuncture Society. - : SAGE Publications. - 0964-5284. ; 26:1, s. 33-45
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Tidskriftsartikel (refereegranskat)abstract
- Pain is a unique personal experience showing variability where gender and sex related effects might contribute. The mechanisms underlying the differences between women and men are currently unknown but are likely to be complex and involving interactions between biological, sociocultural and psychological aspects. In women, painful experimental stimuli are generally reported to produce a greater intensity of pain than in men. Clinical pain is often reported with higher severity and frequency, longer duration, and present in a greater number of body regions in women than in men. Women are also more likely to experience a number of painful conditions such as fibromyalgia, temporomandibular dysfunction, migraine, rheumatoid arthritis and irritable bowel syndrome. With regard to biological factors, quantitative as well as qualitative differences in the endogenous pain inhibitory systems have been implicated, as well as an influence of gonadal hormones. Psychosocial factors like sex role beliefs, pain coping strategies, and pain related expectancies may also contribute to the differences. Being exposed to repeated painful visceral events (eg menses, labour) during life may contribute to an increased sensitivity to, and greater prevalence of, pain among women. When assessing the outcome of pharmacological and non-pharmacological therapies in pain treatment, the factors of gender and sex should be taken into account as the response to an intervention may differ. Preferably, treatment recommendations should be based on studies using both women and men as the norm. Due to variability in results, findings from animal studies and experiments in healthy subjects should be interpreted with care.
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| 14. |
- Lundeberg, T, et al.
(författare)
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Acupuncture for preconditioning of expectancy and/or Pavlovian extinction
- 2008
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Ingår i: Acupuncture in medicine : journal of the British Medical Acupuncture Society. - : SAGE Publications. - 0964-5284. ; 26:4, s. 234-238
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Tidskriftsartikel (refereegranskat)abstract
- Both specific and non-specific factors, as well as the therapist, may play a role in acupuncture therapy. Recent results suggest that verum acupuncture has specific physiological effects and that patients’ expectations and belief regarding a potentially beneficial treatment modulate activity in the reward and ‘self-appraisal’ systems in the brain. We suggest that acupuncture treatment may partly be regarded and used as an intervention that preconditions expectancy, which results in both ‘conditional reflexes’ and conditioning of expected ‘reward’ and ‘self-appraisal’. If so, acupuncture should preferably be applied before the start of the ‘specific’ treatment (drug or behavioural intervention which is given with the intention of achieving a specific outcome) to enhance the specific and non-specific effects. This hypothesis is further supported by the suggestions that acupuncture may be viewed as a ‘neural’ stimulus that triggers Pavlovian ‘extinction’. If this is the case, acupuncture should preferably be applied repeatedly (ie in a learning process) before the start of the ‘specific’ treatment to initiate the extinction of previous unpleasant associations like pain or anxiety. Our clinical data suggest that acupuncture may precondition expectancy and conditional reflexes as well as induce Pavlovian ‘extinction’. Based on the above we suggest that acupuncture should be tried (as an adjunct) before any ‘specific’ therapy.
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| 15. |
- Lundeberg, T, et al.
(författare)
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Acupuncture--self-appraisal and the reward system
- 2007
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Ingår i: Acupuncture in medicine : journal of the British Medical Acupuncture Society. - : SAGE Publications. - 0964-5284. ; 25:3, s. 87-99
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Tidskriftsartikel (refereegranskat)abstract
- Acupuncture is an ancient therapy with a variety of different explanatory models. A cascade of physiological effects has been reported, both in the peripheral and the central nervous system, following the insertion of a needle or light tapping of the skin. Clinical trials testing the specific claims of acupuncture have generally tried to focus on testing the efficacy of applying specific techniques and/or specified points. However, different conditions may respond differently to different modes of stimulation. Recently, it was demonstrated that both superficial and deep needling (with de qi/Hibiki) resulted in amelioration of patellofemoral pain and unpleasantness. The pleasurable aspect of the acupuncture experience has largely been ignored as it has been considered secondary to its pain alleviating effects. This aspect of acupuncture treatment is likely to be related to activation of self-appraisal and the reward system. When a patient seeks a therapist there are expectations of a specific effect. These expectations are partly based on self-relevant phenomena and self-referentia introspection and constitute the preference. Also, when asked about the effect of the treatment, processes that orientate pre-attentive anticipatory or mnemonic information and processes that mediate self-reflection and recollection are integrated together with sensory detection to enable a decision about the patient's perception of the effect of acupuncture treatment. These ‘self-appraisal’ processes are dependent on two integrated networks: a ventral medial prefrontal cortex paralimbic limbic ‘affective’ pathway and a dorsal medial prefrontal cortex cortical hippocampal ‘cognitive’ pathway. The limbic structures are implicated in the reward system and play a key role in most diseases and illness responses including chronic pain and depression, regulating mood and neuromodulatory responses (eg sensory, autonomic, and endocrine). The pleasurable and neuromodulatory aspects of acupuncture as well as ‘placebo needling’ may partly be explained by the activation or deactivation of limbic structures including the hippocampus, amygdala, and their connections with the hypothalamus. In patients with patellofemoral pain, the effects of superficial and deep needling remained for six months. These long term pain-alleviating effects have been attributed to activation of pain inhibiting systems in cortical and subcortical pathways. When considering long term effects the cortical cerebellar system needs to be taken into account. The cortical cerebellar system is probably central to the development of neural models that learn and eventually stimulate routinely executed (eg motor skills) and long term (eg pain alleviation) cognitive processes. These higher order cognitive processes are initially mediated in prefrontal cortical loci but later shift control iteratively to internal cerebellar representations of these processes. Possibly part of the long term healing effects of acupuncture may be attributed to changes in the cerebellar system thereby sparing processing load in cortical and subcortical areas. As cortical and subcortical structures are activated and/or de-activated following stimulation of receptors in the skin, disregarding site, ‘placebo or sham needling’ does not exist and conclusions drawn on the basis that it is an inert control are invalid. ‘Self’ may be seen as a shifting illusion, ceaselessly constructed and deconstructed, and the effect of acupuncture may reflect its status (as well as that of the therapist).
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| 16. |
- Lundeberg, T, et al.
(författare)
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Are reviews based on sham acupuncture procedures in fibromyalgia syndrome (FMS) valid?
- 2007
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Ingår i: Acupuncture in medicine : journal of the British Medical Acupuncture Society. - : SAGE Publications. - 0964-5284. ; 25:3, s. 100-6
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Tidskriftsartikel (refereegranskat)abstract
- In recent reviews regarding the efficacy of acupuncture in fibromyalgia syndrome (FMS) it has been concluded that acupuncture has no specific effect since the control procedure (superficial needling and/or needling away from ‘specific’ points) had similar effects. These conclusions may be questioned since superficial needling and/or needling away from specific trigger points is not inert. Also, manual acupuncture or mild electroacupuncture (EA) may not be sufficient to activate the endogenous pain inhibiting system.Patients with FMS suffer from allodynia, fatigue and muscle ache, which is partly explained by peripheral and central sensitisation. Sensitisation results in augmented and altered stimulus responses whereby light stimulation of the skin has as strong an effect as regular needling on the pain inhibitory system in FMS.Central sensitisation in FMS is also associated with expanded receptive fields of central neurons resulting in a larger topographic distribution of the pain. This would suggest that control procedures using needling away from the ‘specific site’ might have as strong an effect as needling within the most painful area. Also, repeated nociceptive input from muscles (as obtained by de qi) results in expansion of receptive fields which in turn may result in activation of descending pain inhibition outside the stimulated myotome.Sensitisation to pain, such as in FMS, may also be related to abnormalities in descending efferent pathways. As there is likely to be an imbalance between excitatory and inhibitory systems in FMS, stronger stimulation may therefore be needed to activate the descending pain inhibitory system. In studies using mild manual acupuncture or weak EA stimulation optimal pain inhibition may therefore not have been obtained.When conducting studies on acupuncture, the clinical condition or syndrome needs to be taken into account and the control procedure designed accordingly.
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| 17. |
- Lundeberg, T, et al.
(författare)
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Did 'The Princess on the Pea' suffer from fibromyalgia syndrome? The influence on sleep and the effects of acupuncture
- 2007
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Ingår i: Acupuncture in medicine : journal of the British Medical Acupuncture Society. - : SAGE Publications. - 0964-5284. ; 25:4, s. 184-97
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Tidskriftsartikel (refereegranskat)abstract
- Fibromyalgia syndrome (FMS) is a chronic pain syndrome characterised by central sensitisation resulting in hypersentivity of the skin and deeper tissues as well as fatigue. Possibly the princess in Hans Christian Andersen's ‘The Princess and the Pea’ suffered from FMS since chronic sleep disturbances are typical in FMS. These sleep disturbances have been attributed to a dysfunction in the systems regulating sleep and wakefulness resulting in loss of deep sleep. In addition, many patients with FMS experience cognitive dysfunction, characterised by impaired concentration and short term memory consolidation, a complaint also commonly reported in other sleep disorders. In recent reviews evaluating the efficacy of acupuncture in FMS it has been concluded that acupuncture has no specific effect. A prerequisite for this conclusion is that all the major symptoms in the syndrome have been assessed. However, previous studies have generally focused on the pain alleviating effect of acupuncture in FMS. We have observed that not only pain but also sleep and cognitive dysfunction may be ameliorated in response to acupuncture, suggesting that these variables should be taken into account when evaluating the effects of acupuncture in FMS. Furthermore, the results demonstrated great individual variability apart from the systematic effects related to the group, indicating that individually performed treatment strategies are required. Our suggestion is supported by experimental and clinical studies showing that acupuncture may affect in somnia and alertness, and that there may be neurophysiologic bases for these specific effects.
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| 18. |
- Lundeberg, T, et al.
(författare)
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Is there a role for acupuncture in endometriosis pain, or 'endometrialgia'?
- 2008
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Ingår i: Acupuncture in medicine : journal of the British Medical Acupuncture Society. - : SAGE Publications. - 0964-5284. ; 26:2, s. 94-110
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Tidskriftsartikel (refereegranskat)abstract
- Endometriosis is a common cause of pelvic pain in women, many of whom suffer a progression of symptoms over their menstrual life. Symptoms may include combinations of abnormal visceral sensations and emotional distress. Endometriosis pain, or ‘endometrialgia’ often has a negative influence on the ability to work, on family relationships and sense of worth. Endometrialgia is often considered to be a homogeneous sensory entity, mediated by a specialised high threshold sensory system, which extends from the periphery through the spinal cord, brain stem and thalamus to the cerebral cortex. However, multiple mechanisms have been detected in the nervous system responsible for the pain including peripheral sensitisation, phenotypic switches, central sensitisation, ectopic excitability, structural reorganisation, decreased inhibition and increased facilitation, all of which may contribute to the pain. Although the causes of endometrialgia can differ (eg inflammatory, neuropathic and functional), they share some characteristics. Endometrialgia may be evoked by a low intensity, normally innocuous stimulus (allodynia), or it may be an exaggerated and prolonged response to a noxious stimulus (hyperalgesia). The pain may also be spontaneous in the absence of any apparent peripheral stimulus. Oestrogens and prostaglandins probably play key modulatory roles in endometriosis and endometrialgia. Consequently many of the current medical treatments for the condition include oral drugs, like non-steroid anti-inflammatory drugs, contraceptives, progestogens, androgenic agents, gonadotrophin releasing hormone analogues, as well as laparoscopic surgical excision of the endometriosis lesions. However, management of pain in women with endometriosis is currently inadequate for many. Possibly acupuncture and cognitive therapy may be used as an adjunct.
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| 19. |
- Lundeberg, T, et al.
(författare)
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The Emperors sham - wrong assumption that sham needling is sham
- 2008
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Ingår i: Acupuncture in medicine : journal of the British Medical Acupuncture Society. - : SAGE Publications. - 0964-5284. ; 26:4, s. 239-242
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Tidskriftsartikel (refereegranskat)abstract
- During the last five years a large number of randomised controlled clinical trials (RCTs) have been published on the efficacy of acupuncture in different conditions. In most of these studies verum is compared with sham acupuncture. In general both verum and sham have been found to be effective, and often with little reported difference in outcome. This has repeatedly led to the conclusion that acupuncture is no more effective than placebo treatment. However, this conclusion is based on the assumption that sham acupuncture is inert. Since sham acupuncture evidently is merely another form of acupuncture from the physiological perspective, the assumption that sham is sham is incorrect and conclusions based on this assumption are therefore invalid. Clinical guidelines based on such conclusions may therefore exclude suffering patients from valuable treatments.
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| 20. |
- Lundeberg, T, et al.
(författare)
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Treatment recommendations should take account of individual patient variation not just group responses
- 2009
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Ingår i: Acupuncture in medicine : journal of the British Medical Acupuncture Society. - : SAGE Publications. - 1759-9873. ; 27:1, s. 31-32
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Tidskriftsartikel (refereegranskat)abstract
- Recommendations for treatment are commonly based on results evaluating variation in systematic effects (group responses) from randomised controlled trials without taking the individual patient's variation into account. In the evaluation of acupuncture-related treatment effects, the trial design and statistical analysis used are a challenge since the assessed variables commonly have subjective properties and are based on the person's own self-report. Thus, the results that are seen are often varied, most likely due to inter-individual variation in rating of the actual variable such that the treatment effects are expressed more (or less) in some individuals than in others. The basis for the individual variation is probably multi-modal and could be related to the individuals’ expectation, gender, genetic polymorphisms and the aetiology of the condition. The assessment methods used should preferably have proven useful in controlled trials, and the methods for statistical analysis should consider the non-metric properties of the variable and the contribution of the individuals’ variation in the results. In order to evaluate the treatment effects more properly and increase the possibility of detecting any effectiveness, it is therefore important to assess the level of perceived dysfunction or symptom, taking into account the individual variation as well as the systematic effects (the effects of the group). In the evaluation of acupuncture effects, both systematic and individual variation should be reported allowing for the detection of subgroup effects and thereby leading to treatment recommendations that are more likely to be based on each individual's specific needs.
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| 21. |
- Norrbrink, C, et al.
(författare)
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Acupuncture and massage therapy for neuropathic pain following spinal cord injury: an exploratory study
- 2011
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Ingår i: Acupuncture in medicine : journal of the British Medical Acupuncture Society. - : SAGE Publications. - 1759-9873. ; 29:2, s. 108-115
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Tidskriftsartikel (refereegranskat)abstract
- The study sought to explore the possibility of using acupuncture and massage therapy for relieving neuropathic pain following spinal cord injury (SCI). Design 30 individuals with SCI and neuropathic pain were assigned to treatment of either massage or acupuncture, with 15 individuals in each group. Both groups received treatment twice weekly for 6 weeks. Treatments were evaluated at the end of treatment and 2 months later (follow-up). Results Data were analysed on an intention-to-treat basis. Within the groups, ratings of present pain, general pain, pain unpleasantness and coping improved significantly at the end of treatment after acupuncture compared to baseline values, and following massage therapy ratings of pain interference on the Multidimensional Pain Inventory improved. At follow-up no significant improvements were seen. Between-group differences were seen regarding ratings of worst pain intensity at the end of treatment, and regarding pain unpleasantness and coping with pain at follow-up, both in favour of acupuncture. At the end of treatment, eight of the 15 individuals receiving acupuncture and nine receiving massage reported an improvement on the Patient Global Impression of Change Scale, and at follow-up six patients in the acupuncture group and one patient in the massage group still reported a favourable effect from the treatment. Few side effects were reported and neither dropout from the study did this due to adverse events. Conclusion Neuropathic pain following SCI is often only partially responsive to most interventions. Results from this study indicate, however, that both acupuncture and massage therapy may relieve SCI neuropathic pain. For this reason, larger randomised controlled trials are warranted for assessing the long-term effects of these treatments.
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| 22. |
- Nystrom, E, et al.
(författare)
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Manual acupuncture as an adjunctive treatment of nausea in patients with cancer in palliative care--a prospective, observational pilot study
- 2008
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Ingår i: Acupuncture in medicine : journal of the British Medical Acupuncture Society. - : SAGE Publications. - 0964-5284. ; 26:1, s. 27-32
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Tidskriftsartikel (refereegranskat)abstract
- Good clinical evidence has been reported for the effect of PC6 acupuncture in preventing or attenuating postoperative and pregnancy related nausea. Our primary aim was to examine whether PC6 acupuncture during a period of chemotherapy could complement pharmacological treatment of nausea in cancer patients in the palliative stage of their disease. Method We conducted a prospective observational pilot study to measure changes in nausea, and also explored the relationship between nausea, pain and constipation. Twelve patients suffering from nausea and four nausea free patients participated in the study. The nausea free patients were included because they had been troubled by nausea in a previous course of chemotherapy, despite medication with antiemetic drugs, and were about to start a new course of treatment. The patients rated their intensity of nausea, pain and constipation on a numerical rating scale before each of 10 treatment sessions with PC6 acupuncture over the course of three weeks, and at two follow ups during the following week. Results Fifteen patients completed the study. Compared to before treatment, the patients scored a significantly reduced intensity of nausea before the last treatment session (P<0.01) and at the first follow up (P<0.05). Three out of four nausea free patients were still nausea free before the last treatment session with acupuncture. No relationship could be found between nausea, pain and constipation before, during or after the treatment period had finished. Conclusion The study demonstrated that acupuncture treatment in cancer patients can be associated with a significantly reduced intensity of nausea during a period of chemotherapy in their final phase of life.
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| 23. |
- Reinthal, Marianne, et al.
(författare)
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Effects of minimal acupuncture in children with infantile colic - a prospective, quasi-randomised single blind controlled trial.
- 2008
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Ingår i: Acupuncture in medicine : journal of the British Medical Acupuncture Society. - : SAGE Publications. - 0964-5284. ; 26:3, s. 171-82
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Tidskriftsartikel (refereegranskat)abstract
- Background Colic causes crying in 10-30% of infants and is one of the primary reasons parents seek health care. Treatments are generally not totally effective and some cause side effects. In this study we aimed to test the effect of light needling (minimal acupuncture) on crying. METHODS: Forty children (median six weeks of age) with excessive crying unresponsive to conventional therapies, were recruited from 21 Child Welfare Clinics within an area of western Sweden, and quasi-randomised to control or light needling treatment. Parents were unaware of which group their child was assigned to. Children were given light needling acupuncture on one point (LI4) on both hands for approximately 20 seconds on four occasions, or received the same care except needling. Parental assessment questionnaires were used pre- and post-treatment to assess crying intensity, frequency, duration of crying and pain related behaviour throughout the day in six hour periods. RESULTS: Light needling resulted in a significant reduction in the rated crying intensity (assessed by a numeric rating scale, 0 to 10). For example, during the morning time period 0600-1200 hours, the median (range) rated crying intensity changed from 6 (1 to 9) pre-treatment to 2 (0 to 5) post-treatment (P=0.002), in the light needling group. The corresponding ratings for the children in the control group was 6 (0 to 10) and 5 (0 to 10) respectively. The difference between the groups was significant (P=0.016). There were also significant differences between the groups for the afternoon (1200-1800 hours), and evening (1800-midnight) time periods. Pain related behaviour like facial expression, was also significantly less pronounced in the light needling group as compared to the control group post-treatment, (P=0.027). The parents rated the light needling as more effective in improving symptoms than the control group (P<0.001). CONCLUSION: Four treatments with light needling on one point in the hand may alleviate crying and pain related behaviour without any noted side effects.
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| 24. |
- Reinthal, Marianne, et al.
(författare)
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Infantile colic: More than the mother
- 2011
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Ingår i: Acupuncture in Medicine. - : SAGE Publications. - 0964-5284 .- 1759-9873. ; 29
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Tidskriftsartikel (refereegranskat)
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| 25. |
- Vixner, Linda, et al.
(författare)
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Associations between maternal characteristics and women’s responses to acupuncture during labour: a secondary analysis from a randomised controlled trial
- 2017
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Ingår i: Acupuncture in Medicine. - : SAGE Publications. - 0964-5284 .- 1759-9873. ; 35:3, s. 180-188
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Tidskriftsartikel (refereegranskat)abstract
- Background Patient characteristics are modulators of pain experience after acupuncture treatment for chronic pain. Whether this also applies to labour pain is unknown.Aim To examine for associations between maternal characteristics and response to acupuncture in terms of labour pain intensity in close proximity to the treatment (within 60 min) and over a longer time period (up to 240 min), and whether or not epidural analgesia is used, before and after adjustment for obstetric status upon admission to the labour ward.Methods Cohort study (n=253) using data collected for a randomised controlled trial. Associations were examined using linear mixed models and logistic regression analyses. Tests of interactions were also applied to investigate whether maternal characteristics were influenced by treatment group allocation.Results In close proximity to the treatment, advanced age and cervical dilation were associated with lower pain scores (mean difference (MD) −13.2, 95% CI −23.4 to −2.9; and MD −5.0, 95% CI −9.6 to −0.5, respectively). For the longer time period, labour pain was negatively associated with age (MD −11.8, 95% CI −19.6 to −3.9) and positively associated with dysmenorrhoea (MD 5.5, 95% CI 1.6 to 9.5). Previous acupuncture experience and advanced cervical dilatation were associated with higher and lower use of epidural analgesia (OR 2.7, 95% CI 1.3 to 5.9; and OR 0.3, 95% CI 0.1 to 0.5, respectively). No interactions with treatment allocation were found.Conclusions This study did not identify any maternal characteristics associated with women's responses to acupuncture during labour.Trial registration number NCT01197950; Post-results.
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