Acupuncture Research
The research articles outlined below can be used to promote the use of acupuncture
in pregnancy. Some like the articles on pelvic pain, nausea and vomiting and breech
presentations have been selected for their publication in medical and midwifery
journals readily accessible to medical professionals. Others such as the prebirth
and cervical ripening articles are included as they represent the research available
to date.
While clinical practice does not always reflect the methods used in research and
questions remain over the use of methods such as a placebo in acupuncture, or the
use of prescribed points rather than an individual diagnosis, western medical research
does offer opportunities to discuss and promote acupuncture to medical professionals
and the community. This is especially relevant in the area of obstetrics were safety
and evidenced based practice are primary concerns.
Acupuncture use for the treatment of depression in pregnancy
Manber R, Schnyer R, Lyell D, Chambers A, Caughey A, Druzin M, et al. Acupuncture
for depression during pregnancy: a randomized controlled trial. Obstet Gynecol 2010;115:511–20.
A randomised control trial to evaluate the efficacy of acupuncture for pregnant
women diagnosed with major depressive disorder.
Summary
150 pregnant women between 12 and 30 weeks with a diagnosis of major depressive
disorder received either:
- Individualised acupuncture treatment
- Control acupuncture treatment (not specifically designed to treat depression)
- Massage treatment
141 women completed treatment, with similar depression severity and history on entering
the study for all groups. Women receiving the individualised acupuncture treatment
experienced a significantly greater reduction in the Hamilton Rating Score for Depression
and demonstrated a significantly greater response rate than those women assigned
to the control acupuncture group alone or the control acupuncture and massage group
combined. Minimal acupuncture-related side effects were reported and consisted of
discomfort and bleeding at the site of insertion. Ten adverse pregnancy related
events occurred, including that of a premature delivery, a pregnancy loss and hospitalisation
for pregnancy related events; these were found to be unrelated to treatment and
were not significantly different for the three treatment groups. The primary outcome
was the Hamilton Rating Score for Depression, administered on entry into the study
and at four and eight weeks of treatment.
Treatment Methods
Treatment was administered twice a week for four weeks then weekly for four weeks.
An attempt was made to blind the acupuncturists providing the treatment. To achieve
this, for each woman a specifically individualised treatment for depression as well
as a control acupuncture treatment was designed by one group of acupuncturists;
another group of acupuncturists then provided the prescribed treatment, without
evaluating any presenting signs and symptoms. Acupuncture needles were inserted
to depth to obtain deqi and retained for 20 minutes with 7–12 points selected for
each session. The massage treatment was provided by massage therapists. Instructions
were also given to the treatment providers to minimise verbal communication and
refrain from offering any counselling, dietary or lifestyle advice. The primary
outcome was the Hamilton Rating Score for Depression, administered on entry into
the study and at four and eight weeks of treatment.
Conclusion
The acupuncture protocol specifically designed for depression in this study demonstrated
a response rate that was clinically meaningful and comparable to that of standard
care within a similar timeframe. The attempt to blind acupuncture treatment providers
through separating clinical diagnosis from acupuncture treatment was not successful,
with the treatment expectations for the treating acupuncturists found to be significantly
lower in the treatment not specifically designed for depression
Clinical Perspective
Depression during pregnancy is now being increasingly recognised as being a concern
with similar rates occurring as with postpartum depression. This article is useful
for those acupuncturists wanting to promote this area of their practice to midwives,
GPs and obstetricians as it demonstrates both the safety of using acupuncture in
pregnancy and the value of using of individualising treatment. The attempt made
by the authors of this study to blind the acupuncturists delivering treatment was
an interesting approach. It is possible that acupuncture diagnosis, with its focus
on patient observation, limits any attempts to create a control group in this way.
http://www.ncbi.nlm.nih.gov/pubmed/20177281