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Poskus iz splošne prakse [1], ki je vključeval 400 ljudi, trpečih za migreno, je proučeval učinek 12 terapij individualizirane akupunkture v obdobju treh mesecev in učinek običajnega zdravljenja.
Odkrili so, da je bil po enem letu znatno večji napredek, kar se tiče simptomov glavobola, pri 34% udeležencev akupunkture v primerjavi z deležem le 16% udeležencev standardnega zdravljenja. To se je pokazalo v letnem povprečju dni z glavoboli, kjer je bilo 22 dni manj. Če primerjamo rezultate s skupino s standardnim zdravljenjem, je skupina z akupunkturo zaužila 15% manj zdravil, opravila 25% manj obiskov pri svojem splošnem zdravniku in si za 15% manjkrat vzela bolniški dopust.
To je pomembna novica, saj je bilo izvedenih veliko ‘znanstvenih raziskav’, ki pa ne predstavljajo niti resničnih življenjskih okoliščin niti ne demonstrirajo prave TKM. Akupunktura in tradicionalna kitajska medicina sta se razvili že pred tisočimi leti nazaj, in sicer temeljita na najneposrednejšem dotiku in stiku. Naša diagnostika mora biti opravljena s človeškim dotikom. Res je, da človeške oči ne morejo gledati skozi telo kot rentgen, in res je, da je superračunalnik premagal človeka v najzapletenejši igri šaha, vendar ne more noben stroj začutiti človekovega duhovnosti, kot jo lahko živo bitje. Celo vaš pes ali mačka lahko to opravita bolje kot stroj.
S placebom nadzorovani ‘dvojno slepi’ poskus z naključno izbranim vzorcem je predpostavljen za najboljši zlati dokaz v kliničnih raziskavah. To pomeni, da zdravljenje, običajno z zdravili, primerjajo s placebom oz. lažno tableto popolnoma enakega videza, da ne more niti pacient niti raziskovalec vedeti, kaj je kaj. To je narejeno z namenom, da zmanjšajo kakršnakoli pričakovanja o zdravljenju, kot so predsodki, ki bi lahko vplivali na končni rezultat.
Kakorkoli, akupunktura je že sama po sebi preveč drugačna, da bi lahko z lahkoto ustrezala v okolico. Na univerzi v Hong Kongu sem za kratek čas delala kot znanstvena sodelavka , kjer sem bila deležna izkušenj iz prve roke. Ena izmed metod je lažna akupunktura, kjer so igle zapičene v kožo manj globoko in stran od klasičnih akupresurnih točk. Metoda se zanaša predvsem na to, da pacient ne ve, kje so prave točke, in deluje najbolje na tistih, ki akupunkture niso izkusili še nikoli prej. Druga metoda je raba posebne igle, ki je v ovojnici, zato je pred pacientom skrita. Tako lahko iglo zabodejo v kožo kot običajno ali pa jo samo zbodejo, ampak je ne vzdražijo (placebo). To se je izkazalo za metodo, ki učinkovito oponaša občutke prave akupunkture. Obstaja veliko polemik o tem, ali sta ti metodi resnično neaktivni, kot je npr. placebo zdravilo, in ali imata morda posebne učinke, ker stimulirata živčna vlakna pod kožo. Drug problem je, da izvajalci TKM nikoli ne morejo biti ‘oslepljeni’; vedno vedo, katere vrste zdravljenje izvajajo. Zaradi tega razloga morajo biti rezultati zdravljenj ovrednoteni s strani drugega raziskovalca, ki ne ve, kateri pacient je prejel katero zdravljenje, ali pa s strani pacienta samega.
Menim, da je skupinska primerjava ena izmed resničnih in praktičnih raziskovalnih metod za določanje učinkovitosti TKM. Izbere se reprezentativna in statistično umerjena velika skupina, ki je deležna TKM zdravljenja, to pa se potem primerja z rezultati standardne medicine. Poleg tega mora biti zdravljenje in opazovanje načrtovano pristno. Videla sem že mnogo primerov raziskav, ki so proučevale nekaj skrajno zapletenih bolezni s samo 10 zdravljenji v 2 mesecih. To je nesmiselno prekratko. Potrebujemo več raziskav v resničnih in primernih okoliščinah, da bi lahko koristili pacientom.
Čeprav so nadaljnje raziskave potrebne, vključno z najvišjo varnostjo in profilom majhnega števila stranskih učinkov, je akupunktura lahko primerno zdravljenje, ki ga ponudimo ljudem, ki kronično trpijo za glavoboli.
vir: [1]https://www.bmj.com/content/328/7442/744
prevod: Tanja Topić
vir fotografije: internet
Research show benefit from acupuncture for migraine
A general practice based trial [1] involving 400 headache sufferers looked at the effect of 12 sessions over 3 months of individualised acupuncture versus standard care. It found that after 1 year, there was a significantly greater improvement in headache symptoms of 34% compared with controls of 16%. This equated to 22 days less of headaches per year. The acupuncture group used 15% less medication, made 25% fewer visits to their GP, and took 15% less sick days compared to controls.
This is a piece of valuable information because there are quite a lot of “scientific research” that do not represent the real life practice nor demostrature real TCM. Acupuncture and Traditional Chinese medicine were developed thousands years ago based on the most direct human touch and contact. Our diagnostic must be done with human contact. It is true that the human eyes cannot look through the body like x-ray and the supercomputer won human in the most complicated chess game, and yet, no machine can even sense the human spirituality like living creature does, even your dog or cat is better than those super machine.
Randomised, double-blind placebo-controlled trials is regarded as the top “golden evidence” in clinical research. It means that the treatment (typically a drug) is compared with a ‘placebo’ or dummy tablet of identical appearance so that neither the patients nor the researchers know which is which. This is done to minimise treatment expectations, a.k.a. bias, affecting the outcome.
However, acupuncture itself is very different to fit into the settings. I worked as a research associate at University of Hong Kong for a short time and had the first hand experience. One method is called ‘sham’ acupuncture, in which the needles are inserted less deeply into the skin and away from classic acupuncture points. This relies upon the patient not knowing where the true points are and works best in those who have never had acupuncture before. The second method is to use a special needle held in a sheath, which hides it from the patient. The needle can then be made to enter the skin as usual, or to ‘prick’ the skin but not penetrate it (placebo). This has been shown to mimic the sensation of acupuncture effectively. There is much controversy about whether either of these methods are truly inactive like a drug placebo or may have specific effects because they stimulate nerve fibres lying under the skin. The other issue is that practitioners can never be ‘blinded’; they always know which treatment they are giving. For this reason the results of treatment must be assessed by another researcher unaware of which patients got which treatment, or by the patients themselves.
In my opinion, one of the realistic and practical research method to determine the effectiveness of TCM is group comparison. Select a representable and statically important size of sample who undergo TCM treatment and compare them to conventional medicine. Also, set the treatment and observation period realistically. I have seen many researches which investigate some extremely complicated disease with only 10 sessions of treatment in 2 month. This is ridiculous short. We need more researches in a real and appropriate settings in order to benefit patients.
Although further research is needed, with the highest safety and low side effect profile of acupuncture, it may be an appropriate treatment to offer some chronic headache sufferers.
source: [1]https://www.bmj.com/content/328/7442/744
source of photographs: internet
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