Neuro Pathways in cardiovascular electroacupuncture response

Technical article looking at low frequency electroacupuncture in cats at P5 and P6 and the brain circuits responsible for the cardiac sympathoinhibition. Cardiac sympathoinhibition is another way to say a decrease in the stress response. The last blog post was looking at overall increased sympathetic tone in PCOS patients. This particular treatment at P5 and P6 might help to further decrease sympathetic tone in addition to the protocol described by Stener-Vitorin.
(For more information about my acupuncture practice please click here.)

Nucleus raphe pallidus participates in midbrain-medullary cardiovascular sympathoinhibition during electroacupuncture.
Am J Physiol Regul Integr Comp Physiol. 2010 Nov;299(5):R1369-76. Epub 2010 Aug 18.
Li P, Tjen-A-Looi SC, Longhurst JC.

Susan Samueli Center for Integrative Medicine, Department of Medicine, School of Medicine, University of California, Irvine, Irvine, California 92697-4075, USA. pengli@uci.edu
Abstract:
We have shown that electroacupuncture (EA) inhibits sympathoexcitatory rostral ventrolateral medulla (rVLM) neurons and reflex responses following activation of a long-loop pathway in the arcuate nucleus and ventrolateral periaqueductal gray (vlPAG). Additionally, EA at P 5-6 acupoints (overlying the median nerve) activates serotonin-containing neurons in the nucleus raphé pallidus (NRP), which, in turn, inhibit rVLM neurons. Although direct projections from the vlPAG to the rVLM exist, it is uncertain whether an indirect pathway through the NRP serves an important role in vlPAG-rVLM cardiovascular modulation. Therefore, the splanchnic nerve (SN) was stimulated to induce cardiovascular sympathoexcitatory reflexes, and EA was applied at P 5-6 acupoints in a-chloralose-anesthetized cats. A single-barreled recording electrode was inserted into the NRP or rVLM. Microinjection of DL-homocysteic acid (DLH) into the vlPAG increased the NRP neuronal response to SN stimulation (5 ± 1 to 12 ± 2 spikes/30 stim). Likewise, EA at P 5-6 for 30 min increased the NRP response to SN stimulation (3 ± 1 to 10 ± 2 spikes/30 stim), an effect that could be blocked by microinjection of kynurenic acid (KYN) into the caudal vlPAG. Furthermore, the reflex increase in blood pressure induced by application of bradykinin to the gallbladder and the rVLM cardiovascular presympathetic neuronal response to SN stimulation was inhibited by injection of DLH into the vlPAG, a response that was reversed by injection of KYN into the NRP. These results indicate that EA activates the vlPAG, which excites the NRP to, in turn, inhibit rVLM presympathetic neurons and reflex cardiovascular sympathoexcitatory responses.

Is polycystic ovary syndrome associated with high sympathetic nerve activity and size at birth?

This article is back up information about PCOS and high sympathetic tone. They were measuring sympathetic nerve activity to the muscle vascular bed (MSNA.) They found that the heightened MSNA may account for the higher cardiovascular risk in PCOS patients, and postulate that the higher sympathetic tone may account for many of the abnormalities encountered in PCOS. They cite one previous study that explored HRV and PCOS, which I will try to track down. I'm excerpting almost in its entirety for those who might be as interested as I am in this topic.
(For more information about my practice, please click here.)

Yrsa Bergmann Sverrisdo´ttir,1 Tove Mogren,1 Josefin Kataoka,1 Per Olof Janson,2
and Elisabet Stener-Victorin Institute of Neuroscience and Physiology, Department of Physiology, and 2Department of Obstetrics and Gynecology,Sahlgrenska Academy, Go¨teborg University, Go¨teborg, Sweden
Am J Physiol Endocrinol Metab 294: E576–E581, 2008.

Is polycystic ovary syndrome associated with high sympathetic
nerve activity and size at birth?
Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disturbance among women ofreproductive age and is proposed to be linked with size at birth and
increased prevalence of cardiovascular disease. A disturbance in the
sympathetic nervous system may contribute to the etiology of PCOS.
This study evaluates sympathetic outflow in PCOS and its relation to
size at birth. Directly recorded sympathetic nerve activity to the
muscle vascular bed (MSNA) was obtained in 20 women with PCOS
and in 18 matched controls. Ovarian ultrasonographic evaluation,
biometric, hormonal, and biochemical parameters were measured, and
birth data were collected. Women with PCOS had increased MSNA compared with
controls. MSNA was positively related to testosterone and cholesterol levels in PCOS, which, in turn, were not related to each other. Testosterone level was a stronger predictor of MSNA than cholesterol. Birth size did not differ between the study groups. This is the first study to directly address sympathetic nerve activity in women with PCOS and shows that PCOS is associated with high MSNA. Testosterone and cholesterol levels are identified as independent predictors of MSNA in PCOS, although testosterone has a stronger impact. The increased MSNA in PCOS may contribute to the increased cardiovascular risk and etiology of the condition. In this study, PCOS was not related to size at birth.

Polycystic Ovary Syndrome, Electroacupuncture and Exercise

After posting about PCOS and alternative medicine, (see here,) I was able to contact Elisabet Stener-Vitorin and she was kind enough to send a few reprints of other studies of hers. One of the more recent ones looks at low frequency electroacupuncture, exercise, and Polycystic Ovarian Syndrome. The low frequency acupuncture is the most beneficial in reducing androgen levels, acne, and increasing menstrual frequency. That's the good news. The (somewhat) bad news was that the study was carried out over 16 weeks. That's pushing it for most patients in my practice, but perhaps with such evidence on my side, the patience in my patients will improve?
(for more information on my practice please click here.)

Impact of electroacupuncture and physical exercise on hyperandrogenism and
oligo/amenorrhoea in women with polycystic ovary syndrome: A randomized controlled trial
3 Elizabeth Jedel 1, Fernand Labrie 2, Anders Odén 3, Göran Holm 4, Lars Nilsson 5, Per Olof Janson 5,
4 Anna-Karin Lind 5, Claes Ohlsson 6, Elisabet Stener-Victorin 7,8 *
Am J Physiol Endocrinol Metab (October 13, 2010).
ABSTRACT
Background: Polycystic ovary syndrome (PCOS), the most common endocrine disorder in women of reproductive age, is characterized by hyperandrogenism, oligo/amenorrhea, and polycystic ovaries. We aimed to determine whether low-frequency electro-acupuncture (EA) decreases hyperandrogenism and improves oligo/amenorrhea more effectively than physical exercise or no intervention.

Results: After 16 weeks of intervention, circulating T decreased by –25%, androsterone glucuronide by –30%, and androstane-3α, 17β-diol-3glucuronide by –28% in the EA group (P=0.038, 0.030, and 0.047, respectively vs. exercise); menstrual frequency increased to 0.69/month from 0.28 at baseline in the EA group (P=0.018 vs. exercise). After the 16-week follow-up, the acne score decreased by –32% in the EA group (P=0.006 vs. exercise). Both EA and exercise improved menstrual frequency and decreased the levels of several sex steroids at week 16 and at the 16-week follow-up, compared to no intervention.
Conclusion/Significance: Low-frequency EA and physical exercise improved hyperandrogenism and menstrual frequency more effectively than no intervention in women with PCOS. Low-frequency EA was superior to physical exercise and may be useful for treating hyperandrogenism and oligo/amenorrhea.

Polycystic Ovary Syndrome and Acupuncture

There is a review article in the most recent issue of the American Journal of Physiological Endocrinology looking at Complementary Medical methods of approaching Polycystic Ovarian Syndrome. The authors postulate that acupuncture is useful through its "modulation of the activity in the somatic and autonomic nervous system may modulate endocrine and metabolic functions in PCOS." As readers of this blog are aware, the autonomic nervous system is of utmost interest to me, so am always heartened when other researchers and practitioners acknowledge the autonomic nervous system's role in acupuncture effectiveness. They were wary of endorsing herbal treatment for PCOS, because they were unstudied and unproven.
I was also directed to a study from 2008 concerning the evidence and physiology behind acupuncture and Polycystic Ovary Syndrome by the same author Elisabet Stener-Victorin. Stener-Vitorin has established herself as an authority on OB GYN and Acupuncture. (I shared a cab with her after the last Society for Acupuncture Research meeting a year ago and we shared our enthusiasm for the "Girl with the Dragon Tatoo" series. In Swedish the name of the first book is "Men Who Hate Women" instead of "Girl with the Dragon Tatoo." She mused that Swedes are quite realistic and dark compared to Americans. Apparently so, since would guess very few Americans would pick up a book called "Men who Hate Women.")
Excerpts from the two studies follow.
(For more information about my practice please click here.)

The Physiological Basis of Complementary and Alternative Medicine for Polycystic Ovary Syndrome.
Am J Physiol Endocrinol Metab. 2011 Apr 12. [Epub ahead of print]

Raja-Khan N, Stener-Victorin E, Wu X, Legro R.

1Penn State College of Medicine.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder that is characterized by chronic hyperandrogenic anovulation leading to symptoms of hirsutism, acne, irregular menses and infertility. Multiple metabolic and cardiovascular risk factors are associated with PCOS, including insulin resistance, obesity, type 2 diabetes, hypertension, inflammation, and subclinical atherosclerosis. However, current treatments for PCOS are only moderately effective at controlling symptoms and preventing complications. This article describes how the physiological effects of major complementary and alternative medicine (CAM) treatments could reduce the severity of PCOS and its complications. Acupuncture reduces hyperandrogenism and improves menstrual frequency in PCOS. Acupuncture's clinical effects are mediated via activation of somatic afferent nerves innervating the skin and muscle, which via modulation of the activity in the somatic and autonomic nervous system may modulate endocrine and metabolic functions in PCOS. ..

Acupuncture in polycystic ovary syndrome: current experimental and clinical evidence.
J Neuroendocrinol. 2008 Mar;20(3):290-8.
Stener-Victorin E, Jedel E, Mannerås L.

Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden. elisabet.stener-victorin@neuro.gu.se

This review describes the aetiology and pathogenesis of polycystic ovary syndrome (PCOS) and evaluates the use of acupuncture to prevent and reduce symptoms related with PCOS. PCOS is the most common female endocrine disorder and it is strongly associated with hyperandrogenism, ovulatory dysfunction and obesity...The syndrome is associated with peripheral and central factors that influence sympathetic nerve activity. Thus, the sympathetic nervous system may be an important factor in the development and maintenance of PCOS. Many women with PCOS require prolonged treatment. Current pharmacological approaches are effective but have adverse effects. Therefore, nonpharmacological treatment strategies need to be evaluated. Clearly, acupuncture can affect PCOS via modulation of endogenous regulatory systems, including the sympathetic nervous system, the endocrine and the neuroendocrine system. Experimental observations in rat models of steroid-induced polycystic ovaries and clinical data from studies in women with PCOS suggest that acupuncture exert long-lasting beneficial effects on metabolic and endocrine systems and ovulation.

Medication Injuries on the Rise

From the "First, Do No Harm" department, a recent study showing that medication related injuries leading to hospitalizations has increased by 50% in recent years. The data don't take into account patients whose injury did not lead to hospitalization. My point in bringing this up, is not that all medicines are bad or unnecessary or harmful. My issue is that by considering safe alternatives, and not immediately turning to drugs for every ill could save money, and even lives.
For more information about my practice please click here.
Some excerpts of the study follow and the emphases are mine.

April 14, 2011, 2:35 pm
Medication-Related Injuries on the Rise
By TARA PARKER-POPE

The number of people treated in hospitals in the United States for problems related to medication errors has surged more than 50 percent in recent years.

In 2008, 1.9 million people became ill or injured from medication side effects or because they took or were given the wrong type or dose of medication, compared with 1.2 million injured in 2004, according to the Agency for Healthcare Research and Quality.

Although several national reports in recent years have sounded the alarm about the toll of medication errors, the latest data show the problem continues to persist. The A.H.R.Q. data measure only patients treated in the hospital or emergency department as a result of a medication error... Some of the errors resulted from a physician prescribing the wrong drug or dose; others occurred because a pharmacist or nurse gave the wrong drug, or because a patient at home used the wrong type or dose of medication.

In 2006, the Institute of Medicine issued a report citing medication mistakes as the most common medical errors, resulting in an estimated $3.5 billion in added costs for lost wages, productivity and additional health care expenses.

The A.H.R.Q. data showed that among patients who were admitted to the hospital after taking the wrong type or dose of a drug, the most common medications to cause side effects or injuries were corticosteroids. The drugs typically are used to treat asthma, ulcerative colitis or arthritis.

Other drugs that resulted in the highest number of patients admitted to the hospital were pain relievers, blood thinners, cancer drugs and heart and blood pressure medicines.

People older than 65 were most likely to be hospitalized for side effects or medication-related injuries. However, young people were also at risk. One in five emergency cases related to medication problems were children or teenagers.

Link between Allergies and Depression, Recent Studies

There was an article in the NYTimes discussing some recent studies which show a link between allergies and depression. Because an increase in suicide rates occurs in the Spring, the thought it that the manifestation of allergies, not just the genetics, can exacerbate depression.
This correlation is part of the teachings of Chinese Medicine, of course. The lung is the organ that protects the body. As well as its own functions, the lung rules over the skin the major barrier of the body and the nose. Not only is the emotion that is associated with the lung sadness, but also the lung is responsible for shielding the spirit from negative emotions and hostile energies. So it only stands to reason that people with allergies (low lung energy) would also be more susceptible to depression from a Chinese Medicine standpoint.
To read more about allergies and acupuncture please click here.
Some of the article is excerpted here.

April 11, 2011
Allergies Can Increase the Risk of Depression
By ANAHAD O’CONNOR

THE FACTS

Spring always brings a rash of sneezing, sniffling and stuffy noses. But can seasonal allergies be psychologically harmful?

A wave of emerging research suggests that may be the case. While there’s no firm evidence that allergies cause depression, large studies show that allergy sufferers do seem to be at higher risk of depression.

Severe allergies can bring sleeplessness, headaches, fatigue and a general feeling of physical depletion, all of which can worsen mood. Studies have found that allergic reactions release compounds in the body called cytokines, which play a role in inflammation and may reduce levels of the hormone serotonin, which helps maintain feelings of well-being. And it’s well known that some common allergy medications, like corticosteroids, can cause anxiety and mood swings.

Several large studies have found that the risk of depression in people with severe allergies is about twice that of those without allergies. In 2008, researchers at the University of Maryland reported that this link may help explain a widely established — but poorly understood — increase in suicides during the spring every year. Analyzing medical records, the authors found that in some patients, changes in allergy symptoms during low- and high-pollen seasons corresponded to changes in their depression and anxiety scores.

A Finnish population study in 2003 found a link between allergies and depression; however, women were much more likely to be affected. In 2000, a study of twins in Finland also showed a shared risk for depression and allergies, a result of genetic influences, the authors wrote.

Effect of acupuncture on heart rate variability in primary dysmenorrheic women

Dysmenorrhea in layman's terms is menstrual cramps, or menstrual pain. I was not aware that dysmenorrhea had an autonomic component. They used a simple point selection and a simple cross-over design. The subjects had one month with sham acupuncture (SA) and then one month with real acupuncture (RA) or vice versa and the results were compared. They do report the changes in the HRV between sham and real acupuncture, but not whether the patients improved on a pain scale or not. So, to me, this is an interesting study because of the definitive differences in HRV measurements, but whether it would be super interesting to dysmenorrhea sufferers is questionable.

To read more about acupuncture, HRV, and my practice please click here.

Effect of acupuncture on heart rate variability in primary dysmenorrheic women.
Am J Chin Med. 2011;39(2):243-9.
Kim E, Cho JH, Jung WS, Lee S, Pak SC.

Department of Gynecology, College of Oriental Medicine, Kyung Hee University Seoul, South Korea.

Primary dysmenorrhea is a common gynecological complaint among young women that is related to an autonomic nervous system (ANS) disturbance. Acupuncture is one of several therapeutic approaches for primary dysmenorrhea, since it can modulate ANS function. The heart rate variability (HRV) parameters such as high frequency (HF), low frequency (LF) and LF/HF ratio are generally accepted tools to assess ANS activity. The purpose of this study was to investigate the effects of acupuncture applied at Hegu (LI4) and Sanyinjiao (SP6) points on HRV of women with primary dysmenorrhea during the late luteal phase. The experimental design was a crossover and patient-blinded procedure. All subjects participated in Sham (SA) and Real Acupuncture (RA) procedure, separated by one month, in a crossover sequence. The participants included 38 women (mean age 22.3 years; weight 53.8 kg; height 162.6 cm). HRV measurement was 15 min before and 15 min after an acupuncture procedure. The RA procedure was performed at two bilateral acupoints, but needles were inserted subcutaneously to the acupuncture points for the SA procedure. The RA induced a significant decrease in LF/HF ratio and a significant increase in the HF power, while SA treatment caused a significant increase only in the HF power. Manual acupuncture at bilateral acupoints of LI4 and SP6 may play a role in dysmenorrhea treatment with autonomic nervous system involvement.

Estrogen Therapy, Now Recommended Again

This is a good column by Gail Collins on the confusing, conflicting medical studies that are reported by the press and how difficult it is to know what to do when it comes to your own health. My own motto might be described as "less is more." I'll excerpt a few passages that I think are particularly apt. In this article she is referring to the recent study released this week that showed in women with hysterectomies, the women who received estrogen alone (without progesterone) showed a decreased rate of breast cancer. I think the jury's out on this one and would need to see more data. Dr. Sidney Wolfe author of "Worst Pills, Best Pills" is quoted in this article. I keep a copy of his excellent book on my shelf as a reference and he recommends that you never take any medication unless it has been out at least 7 years. And that's what I advise my patients also.
(For more information about my practice click here.)

April 6, 2011
Medicine on the Move
By GAIL COLLINS

Sometimes you really do want to tell the medical profession to just make up its mind.

We got word this week that estrogen therapy, which was bad, is good again. Possibly. In some cases.
This was not quite as confusing as the news last year that calcium supplements, which used to be very good, are now possibly bad. Although maybe not...
Back in the day, estrogen was prescribed only for women who were experiencing serious problems with menopause. Then a 1966 book called “Feminine Forever” argued that estrogen therapy was good for almost every middle-aged female on the planet who wanted to avoid morphing into a crone. The idea grew in popularity even after evidence mounted that the author had been paid by an estrogen manufacturer...
Now comes a new study — from the very same Women’s Health Initiative — that appears to show that for some women, estrogen alone may actually reduce the risk of breast cancer and heart attack. As long as you take it when you’re in your 50s...
Americans should know by now that you can’t put a pill in your mouth without risk. Television is full of commercials for wonder drugs that will perk up your spirits, soothe your allergies or lower your cholesterol, improving life altogether except in the cases where they lead to vivid dreams, suicidal thoughts, hair loss, stabbing pains or sudden death.
But it still feels as if we need to be on guard against medical overoptimism. “Doctors are far more knowledgeable about the benefits of drugs than the risks,” said Dr. Wolfe. There isn’t always much talk about the possible downside of drugs on which all the evidence is yet to come in, like many fertility treatments.

Dr. Wolfe believes that most doctors prefer writing prescriptions to having lengthy discussions with their patients about things like long-term behavior modification therapy. My own theory is that they just tend to want to satisfy their patients. Let’s face it, few of us go to the doctor with hopes of getting advice on behavior modification. They’re medical practitioners, and their instinct is to solve your problems with medicine...

Acupuncture inhibits GABA neuron activity in the ventral tegmental area and reduces ethanol self-administration

This is another study looking at alcohol self-administration, in Rats, mind you, but this one looks at the brain physiology behind acupuncture's effects. Their conclusion was "These findings suggest that DOR-mediated opioid modulation of VTA GABA neurons may mediate acupuncture's role in modulating mesolimbic DA release and suppressing the reinforcing effects of ethanol." I did a previous post looking at those tippling rodents here. They use Heart 7 as their therapeutic point, which implies that they think drinking is more related to the heart and spirit than a liver imbalance. It is close to PC 6 which has been repeatedly shown to decrease the stress response, so very thought provoking in terms of clinical utility.

(To read further about acupuncture, HRV, and my practice please click here.)

Acupuncture inhibits GABA neuron activity in the ventral tegmental area and reduces ethanol self-administration.

Yang CH, Yoon SS, Hansen DM, Wilcox JD, Blumell BR, Park JJ, Steffensen SC.

Daegu Haany University, Daegu, South Korea.
Alcohol Clin Exp Res. 2010 Dec;34(12):2137-46. doi: 10.1111/j.1530-0277.2010.01310.x. Epub 2010 Sep 22.
Abstract

BACKGROUND: Withdrawal from chronic ethanol enhances ventral tegmental area (VTA) GABA neuron excitability and reduces mesolimbic dopamine (DA) neurotransmission, which is suppressed by acupuncture at Shenmen (HT7) points (Zhao et al., 2006). The aim of this study was to evaluate the effects of HT7 acupuncture on VTA GABA neuron excitability, ethanol inhibition of VTA GABA neuron firing rate, and ethanol self-administration. A role for opioid receptors (ORs) in ethanol and acupuncture effects is also explored.

METHODS: Using electrophysiological methods in mature rats, we evaluated the effects of HT7 stimulation and opioid antagonists on VTA GABA neuron firing rate. Using behavioral paradigms in rats, we evaluated the effects of HT7 stimulation and opioid antagonists on ethanol self-administration using a modification of the sucrose-fading procedure.

RESULTS: HT7 stimulation produced a biphasic modulation of VTA GABA neuron firing rate characterized by transient enhancement followed by inhibition and subsequent recovery in 5 minutes. HT7 inhibition of VTA GABA neuron firing rate was blocked by systemic administration of the nonselective μ-opioid receptor antagonist naloxone. HT7 stimulation significantly reduced ethanol suppression of VTA GABA neuron firing rate, which was also blocked by naloxone. HT7 acupuncture reduced ethanol self-administration without affecting sucrose consumption. Systemic administration of the δ-opioid receptor (DOR) antagonist naltrindole blocked ethanol suppression of VTA GABA neuron firing rate and significantly reduced ethanol self-administration without affecting sucrose consumption.

CONCLUSIONS: These findings suggest that DOR-mediated opioid modulation of VTA GABA neurons may mediate acupuncture's role in modulating mesolimbic DA release and suppressing the reinforcing effects of ethanol.
Copyright © 2010 by the Research Society on Alcoholism.

Alcohol Clin Exp Res. 2010 Dec;34(12):2137-46. doi: 10.1111/j.1530-0277.2010.01310.x. Epub 2010 Sep 22.

Improvement of menopausal symptoms with acupuncture not reflected in changes to heart rate variability

This undercuts one of my theories that if someone's autonomics, heart rate variability (HRV) are improved with acupuncture then they are more likely to see improvement in their symptoms. In this study, the patients improved in 11 out of 12 of their symptoms from menopause, but their HRV did not change.

(To read further about acupuncture, HRV, and my practice please click here.)

Improvement of menopausal symptoms with acupuncture not reflected in changes to heart rate variability.

Wright CL, Aickin M.

School of Nursing Portland Campus, 3455 SW US Veterans Road, SN-ORD, Portland, OR 97239, USA; cwright80@hotmail.com.
Acupunct Med. 2011 Mar;29(1):32-9.
Abstract

Hypothesis Studies indicate that menopausal symptoms are relieved by acupuncture. Additional studies have suggested that acupuncture may affect heart rate variability (HRV). This paper reports a pilot study that investigated whether menopausal symptoms responded to acupuncture, and if changes in the spectral analysis of HRV, either suppression of low frequency or augmentation of high frequency bands, corresponded with symptom report. Methods/interventions 12 healthy menopausal subjects were enrolled in this feasibility study. At baseline, subjects were experiencing moderately distressing menopausal symptoms, scoring at least 22 of a possible 44 points on the Menopausal Rating Scale. 10 traditional Chinese medicine-based, protocol acupuncture treatments were administered over a 4 week period, three times a week for 2 weeks, followed by twice a week for 2 weeks. Outcome measures Menopausal Rating Scale questionnaire, 11 menopausal symptoms were evaluated on a zero to four severity scale via self-administered daily checklist for 4 weeks. Dynamic measures of HRV (autoregressive model) were captured before, during and after acupuncture at each session. Spectral analysis of the heart rate was used to compute power in the low frequency and high frequency bands, and their ratio. RESULTS: All subjects complied fully with the protocol without any reported adverse events. While all 11 symptoms showed significant improvement, and one HRV measure changed, on average over the study period, there was essentially no support for a relationship between HRV, menopausal symptom report and acupuncture intervention.

Review of Acupuncture for Infertility

From the available acupuncture literature this group concluded that acupuncture can be of benefit for fertility treatments in women with Polycystic Ovary Disease. In addition, it can increase the rate of live births during embryo transfer for invitro fertilization patients if given on the day of transfer. It can also improve sperm count and motility in males with infertility of idiopathic origin. Interestingly, they do attribute some of acupuncture's success to changes in the autonomic nervous system. So more researchers coming around to my way of thinking?

(To read further about acupuncture, HRV, and my practice please click here.)


Acupuncture in clinical and experimental reproductive medicine: a review.
J Endocrinol Invest. 2011 Feb 4. [Epub ahead of print]
Franconi G, Manni L, Aloe L, Mazzilli F, Giambalvo Dal Ben G, Lenzi A, Fabbri A.

Endocrinology Unit, S. Eugenio and CTO Hospitals, Tor Vergata University, Roma, Italy. giovanna.franconi@uniroma2.it.

Abstract

Background: Acupuncture has been used as treatment for infertility for hundreds of years, and recently it has been studied in male and female infertility and in assisted reproductive technologies, although its role in reproductive medicine is still debated. Aim: To review studies on acupuncture in reproductive medicine, in experimental and clinical settings. Methods: Papers were retrieved on PubMed and Google Scholar and were included in the review if at least the abstract was in English. Results: There is evidence of benefit mainly when acupuncture is performed on the day of embryo transfer (ET) in the live birth rate. Benefit is also evident when acupuncture is performed for female infertility due to polycystic ovary syndrome (PCOS). There is some evidence of sperm quality improvement when acupuncture is performed on males affected by idiopathic infertility. Experimental studies suggest that acupuncture effects are mediated by changes in activity of the autonomic nervous system and stimulation of neuropeptides/neurotransmitters which may be involved in the pathogenesis of infertility. Conclusions: Acupuncture seems to have beneficial effects on live birth rate when performed on the day of ET, and to be useful also in PCOS as well as in male idiopathic infertility, with very low incidence of side effects. However, further studies are necessary to confirm the clinical results and to expand our knowledge of the mechanisms involved.

Cost-Effectiveness of Acupuncture Care as an Adjunct to Exercise-Based Physical Therapy for Osteoarthritis of the Knee

In the U.K. and in Canada "quality-adjusted life years" can be part of their study's outcome measurements and cost-effectiveness. Since both countries have a National Health Service, it is in the Health Services interests to keep people well and in the work force as part of their charter. Since we don't have a collective system in the U.S. the main charter of the Health Insurance Companies is to deny care as much as possible, since their first duty is to their stock holders. But we are entitled to wonder why insurance companies are so reluctant to pay for relatively low cost, high safety profile treatments such as acupuncture. My take is that they are somewhat Machiavellian, in that, once they agree to pay for acupuncture it would lead to more acupuncture treatments, and hence more claims. But it is never discussed in terms of comparing one treatment modality to another, or quality of life. There is an ideological bias in favor of allopathic medicine, also, in spite of the higher costs and risks. I discussed that problem here. In this study they found that both non-penetrating acupuncture and penetrating acupuncture were superior to "advice and exercise" as a cost-effective therapeutic modality even though the cost of delivery was higher than for "advice and exercise" alone. I'm quoting the entire abstract in full for those
who would like to see the details of the analysis.

(To read further about acupuncture, HRV, and my practice please click here.)

Cost-Effectiveness of Acupuncture Care as an Adjunct to Exercise-Based Physical Therapy for Osteoarthritis of the Knee.

Whitehurst DG, Bryan S, Hay EM, Thomas E, Young J, Foster NE.

Centre for Clinical Epidemiology and Evaluation (C2E2), Vancouver Coastal Health Research Institute, 7th Floor, 828 West 10th Ave, Vancouver, British Columbia, V5Z 1M9 Canada. Dr Whitehurst also is Honorary Research Fellow, Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire, United Kingdom.
Abstract

Background The delivery of acupuncture alongside mainstream interventions and the cost-effectiveness of "alternative" treatments remain areas of controversy. Objective The aim of this study was to assess the cost-utility of adding acupuncture to a course of advice and exercise delivered by UK National Health Service (NHS) physical therapists to people with osteoarthritis of the knee. Design A cost-utility analysis was performed alongside a randomized controlled trial.

METHODS: /b> A total of 352 adults (aged 50 years or older) were randomly assigned to receive 1 of 3 interventions. The primary analysis focused on participants receiving advice and exercise (AE) or advice and exercise plus true acupuncture (AE+TA). A secondary analysis considered participants receiving advice and exercise plus nonpenetrating acupuncture (AE+NPA). The main outcome measures were quality-adjusted life years (QALYs), measured by the EQ-5D, and UK NHS costs.

RESULTS: were expressed as the incremental cost per QALY gained over 12 months. Sensitivity analyses included a broader cost perspective to incorporate private out-of-pocket costs. Results NHS costs were higher for AE+TA (£314 [British pounds sterling]) than for AE alone (£229), and the difference in mean QALYs favored AE+TA (mean difference=0.022). The base-case cost per QALY gained was £3,889; this value was associated with a 77% probability that AE+TA would be more cost-effective than AE at a threshold of £20,000 per QALY. Cost-utility data for AE+NPA provided cost-effectiveness estimates similar to those for AE+TA. Limitations As with all trial-based economic evaluations, caution should be exercised when generalizing results beyond the study perspectives.

CONCLUSIONS: /b> A package of AE+TA delivered by NHS physical therapists provided a cost-effective use of health care resources despite an associated increase in costs. However, the economic benefits could not be attributed to the penetrating nature of conventional acupuncture; therefore, further research regarding the mechanisms of acupuncture is needed. An analysis of alternative cost perspectives suggested that the results are generalizable to other health care settings.

(Kristen Sparrow, MD Acupuncture, San Francisco)