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2001 Annual Report | 2001 Introduction | 2001 Projects | 2001 Activities 

2001 Annual Report: Projects

Acupuncture for Low Back Pain Project
Adverse Events Project
Acupuncture in General Practice Project
Acupuncture for Menorrhagia Project
Acupuncture for Depression Project

 ACUMEN: Acupuncture for Menorrhagia Project
 Acupuncture for Depression Project

Low Back Pain Project:  Evaluating the Effectiveness of Acupuncture in the Treatment of Low Back Pain

Back pain is a major cause of ill health and time lost from work.  The ‘orthodox’ treatments often have limited success and the NHS has identified back pain as a priority condition for research.  A literature review revealed that acupuncture can be an effective treatment though there is a lack of high quality research trials. In preparation for a randomised controlled trial, a feasibility study was carried out in 1994 in which GPs referred four patients with chronic low back pain to an acupuncture clinic in York for a course of ten treatments (Fitter & MacPherson, 1995). These results were encouraging in terms of procedures, end-point measures and outcomes.  A full pilot study was undertaken with twenty patients being referred to two acupuncture clinics in York by local GPs and also by consultants from the Pain Clinic at the NHS hospital in York (MacPherson et all 1999). 

In collaboration with Kate Thomas of the Medical Care Research Unit at Sheffield University, this project was developed into a successful application for funding from the Department of Health R & D Health Technology Assessment Programme.  The research design is that of a pragmatic randomised controlled trial to evaluate the evidence for the clinical benefits, the cost effectiveness and the safety of acupuncture for chronic low back pain (Thomas et all 1999). Lucy Thorpe is managing the day-to-day aspects of this trial. The full number of 241 patients were referred by 39 GPs from the York Primary Care Group (now Trust) and then randomised to the offer of acupuncture or to normal GP management.  The acupuncture group received up to 10 treatments from 6 acupuncturists based at three centres in York.   In-depth interviews with selected patients’ focussed on strategies for coping with low back pain and patient’s experience of acupuncture.  The trial started in the summer of 1999 and the twelve-month results will be collected by January 2002 and published later in the year. Funding has been granted for an additional 12 months follow up. The project will finish by April 2003. 

Adverse Events Project: two studies of adverse events following acupuncture.

The safety of acupuncture has come under scrutiny in the UK over the past three years.  As part of establishing the evidence on safety, the Foundation researched much of the source material in the literature and published a series of review articles each one written for a different audience (MacPherson & Gould 1998, MacPherson 1998, MacPherson 1999a, MacPherson 1999c, MacPherson & Lewith 2000).  These papers sifted the evidence, examined the quality of reporting and made proposals for prospective studies to evaluate risks and safety for acupuncture patients.

In 1999 the British Acupuncture Council commissioned the Foundation to undertake a nation-wide prospective survey of practitioners reporting on adverse events. Nicola Owen was the staff member who organised this survey of 572 practitioners who reported for four weeks during May 2000 on all the significant events as well as any minor transient reactions that took place as a result of the treatment they provided.  Between them the practitioners reported events from 34,000 acupuncture treatments. There were no serious adverse events and 43 significant minor adverse events. A short report has recently been published in the British Medical Journal (MacPherson et al 2001a) and a longer version will follow (MacPherson 2001b).

The British Acupuncture Council is now providing funding for a follow-up survey of adverse events as experienced by patients.  Julie Elwick started work on this survey in January 2001. With 7,000 patients in the survey, it will be the first UK-based study of what patients report in terms of the type and frequency of adverse events following acupuncture. This study is breaking new ground both in terms of its patient perspective and in the range of adverse consequences being explored. Results can be expected towards the end of 2002. 

Acupuncture in General Practice: a case study of an acupuncturist working in general practice

Much of the research programme is in pursuit of our goal of exploring what role acupuncture could play in the NHS.  We are therefore interested in the experience of acupuncturists working within the NHS and in ways of making the collaboration as effective as possible.   To this end, we have undertaken a small action research case study to explore the process of establishing and providing an acupuncture service within general medical practice.  A practice in Sheffield employed an acupuncturist on a sessional basis to provide treatment for their patients.  Mike Fitter contributed research expertise to help set up the clinical audit and monitoring systems.  Our aims were to identify:

q       The benefits to patients and GPs of offering acupuncture with general practice

q       The most effective ways of developing collaborative working and an integrated service

Data on the clinical outcomes of the acupuncture treatments has been analysed, a symposium report has been presented by acupuncturist Pam Machin and in 2002 we expect to publish the results as a case study on the delivery of acupuncture within a GP practice. 

ACUMEN: the Acupuncture for Menorrhagia Project

With over 40,000 hysterectomies being performed every year in the UK, the need for women to have a less invasive and more supportive treatment for heavy menstrual periods continues to be an important issue.   Because women can wait can be for between one and two years, and few actually want a hysterectomy, there is an opportunity to evaluate acupuncture as an alternative treatment.  Research in China suggest that around two-thirds of women with heavy menstrual periods can be significantly helped with acupuncture.  Based on these findings, and the experiences of patients and practitioners in the West, the Foundation has designed the ACUMEN Project in collaboration with the Department of Health Sciences at the University of York and the Medical Care Research Unit, University of Sheffield.

The Project will have two phases, where phase one is an exploratory study, designed to explore the possibility of acupuncture having a role in the treatment of menorrhagia and to establish the feasibility of second phase with a full scale randomised controlled trial.  Forty patients are being invited to join the study, half of whom will be randomised to the offer of acupuncture in conjunction with normal GP care while the other half will receive normal GP care only.  The acupuncture group will receive up to 20 acupuncture session on a weekly basis.  This exploratory study will establish the acceptability of such a trial for patients, test referral and other  procedures, including outcome measures, and monitor the costs and safety.  The forty patients will be recruited by the end of 2001.   Six month outcomes will be collected and analysed in 2002 and a bid for the full scale trial will be made by 2003.

The ACUMEN Project is run by Alison Gamon, an acupuncturist who graduated from the Northern College of Acupuncture with an MSc in May 2000. Funding has come from an independent grant-making trust and York University where Alison has been awarded DPhil studentship by the Department of Health Sciences for three years. 

Acupuncture for Depression Project

Depression is a common psychiatric disorder with a prevalence of approximately 5% in the general population.  It is estimated that one-third of the population have experienced an episode of depression during their lifetime. For the individual, depression results in high personal, social and economic costs through social exclusion, disability, deliberate self-harm and health care provision.

The effectiveness of acupuncture in the treatment of depression has been recently reviewed with a strong suggestion of benefit. However there is a need for further research involving randomised controlled trials before firm conclusions can be drawn.

The Acupuncture for Depression Project is planned in two parts: first a pilot study to assess the feasibility of a full-scale pragmatic randomised controlled trial followed second by the full trial itself. We are interested in evaluating the clinical and economic benefits of offering acupuncture to patients with mild/moderate depression assessed as suitable for management in primary care.  The full-scale study will be a pragmatic randomised controlled trial designed to answer questions of the relative effectiveness of acupuncture in a real world setting (e.g. is acupuncture more effective than the accepted conventional treatment for depression?).  As well as evaluating the clinical benefits of offering acupuncture to patients with depression, the study will also evaluate the economic benefits and determine whether acupuncture sufficiently reduces the use of NHS services to outweigh its cost.  To date there have been no cost-effectiveness studies of an acupuncture service for depression.

For the pilot study, a total of 10 patients will be recruited and referred for up to 10 acupuncture treatments.  Eligible patients will be identified by one local GP and will continue to have access to normal GP management. A variety of psychological outcome measures will be used to measure changes in psychological well-being over time.