Acupuncture alone or in conjunction with pharmacotherapy for analgesia in common emergency department presentations

Acupuncture alone or in conjunction with pharmacotherapy for analgesia in common emergency department presentations

Cohen, M., Parker, S., Taylor, D., Smit, D., Ben Meir, M., Cameron, P., Xue, C., (2017) Acupuncture alone or in conjunction with pharmacotherapy for analgesia in common emergency department presentations: A pragmatic, multicentre, randomised, controlled trial. Medical Journal of Australia 

Abstract

OBJECTIVES:
This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain.
DESIGN:
A pragmatic, multicentre, randomised, assessor-blinded, equivalence and non-inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department. Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10-point verbal numerical rating scale (VNRS) of at least 4.
MAIN OUTCOME MEASURES:
The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units.
RESULTS:
1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non-inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention-to-treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between-group differences.
CONCLUSION:
The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed.

Complementary medicine products– interpreting the evidence base

Complementary medicine products– interpreting the evidence base

Cohen, M., Hunter, J. Complementary medicine products– interpreting the evidence base. (2017) Internal Medicine Journal

Abstract

 

Many patients use complementary medicine (CM) products, such as vitamins, minerals and herbs as part of self-care without professional advice or disclosure to their doctors. While use of CM products is gaining awareness by the medical community and there is mounting evidence for their safety, efficacy and cost-effectiveness, there is also the potential for adverse events from inappropriate use and/or withdrawal, as well as interactions with other medicines. Due to the unique and complex properties of many CM products, research evidence is specific to individual preparations and this can lead to confusion when assessing label claims and interpreting the results of clinical trials and systematic reviews. While the Australian regulatory environment for CM products is the same as for prescription medicines and is based on risk, there is a great need for consumers and clinicians to have access to easily understood, evidence-based information to facilitate informed decision-making.

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Complementary Therapies; Have They Become Mainstream in General Practice?

Complementary Therapies; Have They Become Mainstream in General Practice?

Pirotta, M. Cohen M., Kotsirilos, K. Farrish, S. Complementary Therapies; Have They Become Mainstream in General Practice? Medical Journal of Australia, 172: 105 -109, 2000.

Abstract

 

OBJECTIVES:
To describe Victorian general practitioners’ attitudes towards and use of a range of complementary therapies.
DESIGN:
A self-administered postal survey sent to a random sample of 800 general practitioners (GPs) in Victoria in July 1997.
PARTICIPANTS:
488 GPs (response rate, 64%).
MAIN OUTCOME MEASURES:
GPs’ knowledge; opinions about harmfulness and effectiveness; appropriateness for GPs to practise; perceived patient demand; need for undergraduate education; referral rates to complementary practitioners; and training in and practice of each therapy.
RESULTS:
Acupuncture, hypnosis and meditation are well accepted by the surveyed GPs, as over 80% have referred patients patients to practitioners of these therapies and nearly half have considered using them. General practitioners have trained in various therapies–meditation (34%), acupuncture (23%), vitamin and mineral therapy (23%), hypnosis (20%), herbal medicine (12%), chiropractic (8%), naturopathy (6%), homoeopathy (5%), spiritual healing (5%), osteopathy (4%), aroma-therapy (4%), and reflexology (2%). A quarter to a third were interested in training in chiropractic, herbal medicine, naturopathy and vitamin and mineral therapy. General practitioners appear to underestimate their patients’ use of complementary therapies.
CONCLUSIONS:
There is evidence in Australia of widespread acceptance of acupuncture, meditation, hypnosis and chiropractic by GPs and lesser acceptance of the other therapies. These findings generate an urgent need for evidence of these therapies’ effectiveness.
Comment in
Complementary and alternative medicine: an educational, attitudinal and research challenge. [Med J Aust. 2000]

What is Complementary Medicine?

What is Complementary Medicine?

Cohen, M. What is Complementary Medicine? Australian Family Physician Vol 29 No 12, p1125-8, 2000.

Abstract

 

BACKGROUND:
Medicine has a central aim of achieving health and wellbeing and many healthcare practices have developed to achieve this. Currently, patient spending on complementary therapies exceeds out of pocket spending on orthodox therapies. The increased use of complementary medicine by the public is paralleled by many doctors either using, or interested in using, a wider range of therapeutic approaches.
OBJECTIVE:
To define complementary medicine and explore what distinguishes it from mainstream medicine.
DISCUSSION:
Despite growing interest into complementary therapies by doctors and government, it often seems there are two parallel healthcare systems–‘conventional’ and ‘complementary’, or ‘orthodox’ and ‘unorthodox’–operating without much interaction. Descriptions of this division claim to be based on scientific merit or political acceptance. However, it may be more appropriate to consider therapies as existing across a spectrum with multiple, complementary dimensions. Thus, the science of medicine aimed at achieving cures can be seen to complement the art of medicine, which aims to enhance health. Optimal healthcare delivery requires a ‘holistic’ or ‘integrative’ approach.