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Data supporting the use of acupuncture in treating osteoarthritis are growing A 2006 systematic review and metaanalysis of 18 randomized controlled trials concluded that sham-controlled trials suggest specific efficacy of acupuncture for pain control in patients with osteoarthritis of peripheral joints The favorable safety profile makes acupuncture a worthy option of consideration, particularly for knee osteoarthritis Acupuncture plus routine care was associated with marked clinical improvement in a German trial in which 632 patients with osteoarthritis of the hip or knee were randomized to up to 15 sessions of physician-delivered acupuncture or wait-list control for 3 months The treatment protocol was individualized for each patient at the discretion of the physician, more closely reflecting how acupuncture is practiced clinically One-third (345%) of the acupuncture-treated group had a good response after 3 months, compared with 65% of the wait-list control group The improvement in pain and quality of life was maintained at 6-month follow-up In another 2006 study of more than 1000 patients with knee osteoarthritis, both traditional and sham acupuncturetreated patients did better than those treated with medical management alone: approximately half the patients who were needled reported a 36% improvement in the Western Ontario and McMaster Universities Osteoarthritis Index versus 29% in the conservative care group
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There is good evidence suggesting that acupuncture is not effective in maintaining abstinence from nicotine addiction Systematic reviews have identified multiple trials of sufficient quality to determine that there is no evidence to support its use A 2006 Cochrane systematic review of 24 trials concluded there is no consistent evidence that acupuncture or acupressure, laser therapy or electrostimulation are effective for smoking cessation Despite insufficient evidence to support its use, auricular acupuncture is in widespread use throughout American drug treatment facilities Although heroin, alcohol, and cocaine addiction studies have frequently reported positive outcomes, serious methodologic flaws have been found in these studies A 2006 Cochrane systematic review of seven studies in which 1433 patients were treated with ear acupuncture for cocaine dependence concluded that there is currently no evidence to support its use
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Gates S et al Auricular acupuncture for cocaine dependence Cochrane Database Syst Rev 2006 Jan 25;(1): CD005192 [PMID: 16437523] White AR et al Acupuncture and related interventions for smoking cessation Cochrane Database Syst Rev 2006 Jan 25;(1):CD000009 [PMID: 16437420]
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Mind-body medicine is popular Approximately 20% of the US adult population has used one or more mind-body therapies in the past year The more conventional mind-body therapies already are established, supported by evidence, and widely available For example, multimodal mind-body interventions that use some combination of cognitive behavioral therapies, support groups, education, relaxation and skills training have been proven effective for coronary artery disease, cancer, and chronic pain conditions Mind-body therapies also work well as adjunctive treatments, for example with surgery, cancer treatment, and stress (Table 41 4) They also offer the psychological benefit of increasing sense of control for the patient Finally, mind-body therapies can be recommended because they have a very favorable safety profile
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Astin JA et al Mind-body medicine: state of the science, implications for practice J Am Board Fam Pract 2003 Mar Apr;16 (2):131 47 [PMID: 12665179] Barrows KA et al Mind-body medicine An introduction and review of the literature Med Clin North Am 2002 Jan;86(1): 11 31 [PMID: 11795084] National Center for Complementary and Alternative Medicine Website http://nccamnihgov/health/backgrounds/mindbody htm#intervention Wolsko PM et al Use of mind-body medical therapies J Gen Intern Med 2004 Jan;19(1):43 50 [PMID: 14748859]
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MIND-BODY MEDICINE Definition
Mind-body medicine is commonly defined as the field of medicine that uses processes of the mind to influence the health of the body While a useful working definition, it can perpetuate a mind-versus-body dualism, and it fails to acknowledge the bidirectional relationship of mind and body (eg, the fact that aerobic exercise improves mood) It may be more accurate to think of mind/body as a single entity, with the health of one part necessarily influencing the health of the other The NIH has defined mind-body medicine as behavioral, psychological, social, and spiritual approaches to medicine not commonly used This definition distinguishes mind-body medicine therapies from therapies that are more established or mainstream but that may have similar mechanisms of action (eg, psychotherapies, behavioral training, support groups, education) Traditionally defined mind-body therapies include biofeedback, hypnosis, meditation, guided imagery, relaxation techniques, yoga, tai chi, and chi gung
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