Archives of physical medicine and rehabilitation, 2001
Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a s... more Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil 2001;82:986-92.
Best practice & research. Clinical rheumatology, 2007
This chapter defines and describes the condition that is known by the term myofascial trigger poi... more This chapter defines and describes the condition that is known by the term myofascial trigger point pain syndrome. An outline is given of the current state of knowledge of the pathophysiology of myofascial trigger points, including the latest details from needle microdialysis in near real-time. The clinical features of this pain syndrome are summarised in general terms and the reliability of the clinical diagnosis is discussed. The clinical evidence for and against the common therapeutic interventions used in the management of myofascial pain is reviewed in detail and some tentative conclusions are reached with respect to needling therapies.
Objectives. To evaluate the effects of acupuncture on pain and function in patients with chronic ... more Objectives. To evaluate the effects of acupuncture on pain and function in patients with chronic knee pain. Methods. Systematic review and meta-analysis of randomized controlled trials of adequate acupuncture. Computerized databases and reference lists of articles were searched in June 2006. Studies were selected in which adults with chronic knee pain or osteoarthritis of the knee were randomized to receive either acupuncture treatment or a control consisting of sham (placebo) acupuncture, other sham treatments, no additional intervention (usual care), or an active intervention. The main outcome measures were short-term pain and function, and study validity was assessed using a modification of a previously published instrument.
In October 2000 the German Federal Committee of Physicians and Health Insurers recommended that s... more In October 2000 the German Federal Committee of Physicians and Health Insurers recommended that special Model Projects on Acupuncture ("Modellvorhaben Akupunktur") be developed in order to determine the evidence-based role of acupuncture in the treatment of certain illnesses. This paper presents a summary of the main randomised controlled trials performed as part of these projects, and the associated economic analyses. Overall the results show that acupuncture is effective in practice for a range of chronic conditions, and it seems likely to have acceptable cost utility (at least at a rate of euro35 per session). Sham acupuncture, in the form of minimal off-point needling in a therapeutic context, also appears to be effective, being no different to prophylactic medication in migraine, and superior to guideline-based standard care in chronic low back pain. In patients recruited to acupuncture trials, the response to treatment does not differ between those that agree to be randomised and those that do not. This suggests that the results of the pragmatic Acupuncture in Routine Care studies are applicable to patients from the general population who express a preference for acupuncture. In conclusion, acupuncture appears to be effective in a range of chronic conditions and it seems to have acceptable cost-effectiveness in Western health economic terms. These programmes of research do not confirm the hypothesis that needling at specific points is essential to achieve satisfactory clinical effects of acupuncture. Sham acupuncture, in the form of minimal off-point needling in a therapeutic context, is unlikely to be an inactive placebo. In April 2006, the German health authorities decided that acupuncture would be included into routine reimbursement by social health insurance funds for chronic low back pain and chronic osteoarthritis of the knee.
Evidence of effectiveness is increasingly used to determine which health technologies are incorpo... more Evidence of effectiveness is increasingly used to determine which health technologies are incorporated into public health provision. Acupuncture is a popular therapy that has been shown to be superior to placebo in the treatment of nausea and dental pain, and promising for migraine and osteoarthritis of the knee. For many other conditions, such as chronic pain, in which acupuncture is often used, the evidence is either insufficient or negative. Misleading results may occur for a number of reasons. False negative results may arise from inadequate treatment schedules and inappropriate control interventions. This consensus document considers these issues with the aim of improving the design of efficacy trials of acupuncture in order that they are more likely to be conclusive and more meaningfully interpreted. Clinical trials of acupuncture must use an optimal form of treatment; this can be defined by examining standard texts, by surveying and consulting experts. There are a great many variables in treatment (such as point selection, form of stimulation) all of which need to be addressed in designing and reporting clinical trials. The control procedure is determined by the precise research question that is being addressed. For efficacy studies, in which the question is whether acupuncture has specific effects (i.e. is superior to placebo), sham forms of acupuncture appear the most appropriate method of controlling for needle penetration. A recent development of blunted, telescopic needles may represent a major advance. Such procedures may produce a therapeutic response so should preferably be recorded as 'sham' procedures rather than true 'placebo' controls. Blinding in clinical trials is an accepted means of reducing bias. Patient blinding in acupuncture studies can be achieved by sham procedures and its success should be measured. While practitioner blinding is difficult, though not impossible, blinding of the observer and the analyst should be considered as the ideal for all studies. A number of recommendations are made which aim to improve the quality of sham-controlled acupuncture studies. C
Acupuncture in medicine : journal of the British Medical Acupuncture Society, 2011
Electroacupuncture (EA) is becoming more common as a treatment for chronic musculoskeletal pain. ... more Electroacupuncture (EA) is becoming more common as a treatment for chronic musculoskeletal pain. It can be associated with adverse events related to the small electric currents used, in addition to the adverse events related to needle penetration of tissues. This paper reports a case of minor tissue damage following high intensity EA for 30 min with a device delivering a waveform that does not appear to be completely charge-balanced. This case highlights a rare but preventable adverse event. Manufacturers should be encouraged to develop EA stimulators that use charge-balanced waveforms.
Low back pain frequently presents to medical acupuncturists, many of whom are general practitione... more Low back pain frequently presents to medical acupuncturists, many of whom are general practitioners working in the public sector. Under these circumstances there is often limited time to devote to an initial assessment of a patient's presenting complaint. This paper presents an assessment process that is aimed at informing management decisions for medical acupuncturists, although much of the process may be useful to a wider range of practitioners. The assessment is divided into an initial screening procedure, and a further more detailed assessment. The initial screening procedure can usefully be applied in a brief consultation. Using this assessment tool, practitioners with medical acupuncture training will be able to select the cases most likely to be helped by their acupuncture skills.
Medical doctors are particularly cautious about using acupuncture in pregnancy. This derives from... more Medical doctors are particularly cautious about using acupuncture in pregnancy. This derives from the mostly historical and anecdotal claims that acupuncture can promote abortion, coupled with the fact that spontaneous early pregnancy loss is common, and litigation is increasing. This case report describes the circumstances that lead to the author using deep paraspinal and periosteal acupuncture throughout a patient's pregnancy to help control her low back pain.
Acupuncture in medicine : journal of the British Medical Acupuncture Society, 2011
It has been suggested that acupuncture may pose particular risks during pregnancy: by enhancing o... more It has been suggested that acupuncture may pose particular risks during pregnancy: by enhancing oxygenation to the developing embryo (presumably via increasing blood flow to the uterus); by affecting the level of maternal progesterone in early pregnancy; or by stimulating uterine contractions. This article examines the proposed risks and fails to find any plausible physiological mechanism for them.
Acupuncture in medicine : journal of the British Medical Acupuncture Society, 2013
Obesity is one of the leading health risk factors worldwide and is associated with several other ... more Obesity is one of the leading health risk factors worldwide and is associated with several other risk factors and health problems including type 2 diabetes mellitus, cardiovascular disease and malignancies. Current conventional therapeutic strategies for obesity cannot achieve adequate weight control in all patients, so complementary types of treatment are also performed. Acupuncture, one of the oldest healing practices, represents the most rapidly growing complementary therapy which is recognised by both the National Institutes of Health and the WHO. A previous review concluded that acupuncture was superior to lifestyle advice, to sham acupuncture and to conventional medication. In this narrative review, the possible mechanisms of actions and the results of recent experimental and clinical studies with different forms of acupuncture (eg, body, auricular, manual and electroacupuncture) are presented. In particular, the effects of acupuncture on anorexigenic and orexigenic peptides, insulin resistance, lipid metabolism and inflammatory markers are discussed. Both experimental and clinical current data suggest that acupuncture exerts beneficial effects on the mechanisms of obesity. Some data suggest that electroacupuncture may be more effective than manual acupuncture; however, the most effective frequency remains controversial. Combination of different forms of acupuncture with diet and exercise seems to be necessary for achieving and maintaining weight loss. Further prospective clinical trials are needed to establish the effectiveness of this complementary method for obesity treatment.
Complementary and alternative medicine (CAM) is frequently used in patients in industrialised cou... more Complementary and alternative medicine (CAM) is frequently used in patients in industrialised countries. Despite this popularity, there remains a considerable deficit of discourse and cooperation between physicians practicing CAM and conventional medicine. The aim is to present the methodology and results of the first international case conference on integrative medicine (IM) dealing with a patient with low back pain. In this paper the methodological tool "case conference on IM" is also described. The interactive case conference took place on November 20th, 2009 as part of the "2nd European Congress of IM" in Berlin, Germany. An experienced expert panel from both conventional medicine and CAM developed integrative medical diagnoses and therapeutic strategies using as their starting point an individual patient case on chronic low back pain (LBP). The case was selected because LBP is a common diagnosis with considerable economic impact and a problem which is often treated with CAM. In this case conference, the expert panel agreed on a diagnosis of "chronic non-specific LBP with somatic and psychological factors" and proposed multi-modal short- and long-term treatment including of CAM. The importance of the patient-physician-relationship and the consultation process with appropriate consultation time for treatment success was highlighted. There was consensus that the diagnostic process and resulting treatment plan should be individualised and focussed on the patient as a complete person, identifying the significance the disease has for the patient and not just on the disease for itself. Considerable differences were found amongst the experts regarding the first steps of treatment and each expert saw possibilities of "effective and adequate treatment" being met by their own individual treatment method. The case conference on integrative medicine stimulated an intensive exchange between the approaches used by conventional medicine and CAM clarifying different treatment possibilities for low back pain. Therefore, case conferences on integrative medicine could serve as a model for evaluating similar activities in academic hospitals and establishing such approaches in routine medical care. This strategy has the potential to improve patient centred care.
ABSTRACT Acupuncture is increasingly popular, and Woo and colleagues correctly emphasise the need... more ABSTRACT Acupuncture is increasingly popular, and Woo and colleagues correctly emphasise the need to increase awareness of its side effects and for training and regulation.1But the risk of infection is overstated because the editorial is based largely on anecdotal evidence: a 33 year old review, four case reports, a retrospective case series, and one epidemiological study from South Korea. It …
Archives of physical medicine and rehabilitation, 2001
Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a s... more Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil 2001;82:986-92.
Best practice & research. Clinical rheumatology, 2007
This chapter defines and describes the condition that is known by the term myofascial trigger poi... more This chapter defines and describes the condition that is known by the term myofascial trigger point pain syndrome. An outline is given of the current state of knowledge of the pathophysiology of myofascial trigger points, including the latest details from needle microdialysis in near real-time. The clinical features of this pain syndrome are summarised in general terms and the reliability of the clinical diagnosis is discussed. The clinical evidence for and against the common therapeutic interventions used in the management of myofascial pain is reviewed in detail and some tentative conclusions are reached with respect to needling therapies.
Objectives. To evaluate the effects of acupuncture on pain and function in patients with chronic ... more Objectives. To evaluate the effects of acupuncture on pain and function in patients with chronic knee pain. Methods. Systematic review and meta-analysis of randomized controlled trials of adequate acupuncture. Computerized databases and reference lists of articles were searched in June 2006. Studies were selected in which adults with chronic knee pain or osteoarthritis of the knee were randomized to receive either acupuncture treatment or a control consisting of sham (placebo) acupuncture, other sham treatments, no additional intervention (usual care), or an active intervention. The main outcome measures were short-term pain and function, and study validity was assessed using a modification of a previously published instrument.
In October 2000 the German Federal Committee of Physicians and Health Insurers recommended that s... more In October 2000 the German Federal Committee of Physicians and Health Insurers recommended that special Model Projects on Acupuncture ("Modellvorhaben Akupunktur") be developed in order to determine the evidence-based role of acupuncture in the treatment of certain illnesses. This paper presents a summary of the main randomised controlled trials performed as part of these projects, and the associated economic analyses. Overall the results show that acupuncture is effective in practice for a range of chronic conditions, and it seems likely to have acceptable cost utility (at least at a rate of euro35 per session). Sham acupuncture, in the form of minimal off-point needling in a therapeutic context, also appears to be effective, being no different to prophylactic medication in migraine, and superior to guideline-based standard care in chronic low back pain. In patients recruited to acupuncture trials, the response to treatment does not differ between those that agree to be randomised and those that do not. This suggests that the results of the pragmatic Acupuncture in Routine Care studies are applicable to patients from the general population who express a preference for acupuncture. In conclusion, acupuncture appears to be effective in a range of chronic conditions and it seems to have acceptable cost-effectiveness in Western health economic terms. These programmes of research do not confirm the hypothesis that needling at specific points is essential to achieve satisfactory clinical effects of acupuncture. Sham acupuncture, in the form of minimal off-point needling in a therapeutic context, is unlikely to be an inactive placebo. In April 2006, the German health authorities decided that acupuncture would be included into routine reimbursement by social health insurance funds for chronic low back pain and chronic osteoarthritis of the knee.
Evidence of effectiveness is increasingly used to determine which health technologies are incorpo... more Evidence of effectiveness is increasingly used to determine which health technologies are incorporated into public health provision. Acupuncture is a popular therapy that has been shown to be superior to placebo in the treatment of nausea and dental pain, and promising for migraine and osteoarthritis of the knee. For many other conditions, such as chronic pain, in which acupuncture is often used, the evidence is either insufficient or negative. Misleading results may occur for a number of reasons. False negative results may arise from inadequate treatment schedules and inappropriate control interventions. This consensus document considers these issues with the aim of improving the design of efficacy trials of acupuncture in order that they are more likely to be conclusive and more meaningfully interpreted. Clinical trials of acupuncture must use an optimal form of treatment; this can be defined by examining standard texts, by surveying and consulting experts. There are a great many variables in treatment (such as point selection, form of stimulation) all of which need to be addressed in designing and reporting clinical trials. The control procedure is determined by the precise research question that is being addressed. For efficacy studies, in which the question is whether acupuncture has specific effects (i.e. is superior to placebo), sham forms of acupuncture appear the most appropriate method of controlling for needle penetration. A recent development of blunted, telescopic needles may represent a major advance. Such procedures may produce a therapeutic response so should preferably be recorded as 'sham' procedures rather than true 'placebo' controls. Blinding in clinical trials is an accepted means of reducing bias. Patient blinding in acupuncture studies can be achieved by sham procedures and its success should be measured. While practitioner blinding is difficult, though not impossible, blinding of the observer and the analyst should be considered as the ideal for all studies. A number of recommendations are made which aim to improve the quality of sham-controlled acupuncture studies. C
Acupuncture in medicine : journal of the British Medical Acupuncture Society, 2011
Electroacupuncture (EA) is becoming more common as a treatment for chronic musculoskeletal pain. ... more Electroacupuncture (EA) is becoming more common as a treatment for chronic musculoskeletal pain. It can be associated with adverse events related to the small electric currents used, in addition to the adverse events related to needle penetration of tissues. This paper reports a case of minor tissue damage following high intensity EA for 30 min with a device delivering a waveform that does not appear to be completely charge-balanced. This case highlights a rare but preventable adverse event. Manufacturers should be encouraged to develop EA stimulators that use charge-balanced waveforms.
Low back pain frequently presents to medical acupuncturists, many of whom are general practitione... more Low back pain frequently presents to medical acupuncturists, many of whom are general practitioners working in the public sector. Under these circumstances there is often limited time to devote to an initial assessment of a patient's presenting complaint. This paper presents an assessment process that is aimed at informing management decisions for medical acupuncturists, although much of the process may be useful to a wider range of practitioners. The assessment is divided into an initial screening procedure, and a further more detailed assessment. The initial screening procedure can usefully be applied in a brief consultation. Using this assessment tool, practitioners with medical acupuncture training will be able to select the cases most likely to be helped by their acupuncture skills.
Medical doctors are particularly cautious about using acupuncture in pregnancy. This derives from... more Medical doctors are particularly cautious about using acupuncture in pregnancy. This derives from the mostly historical and anecdotal claims that acupuncture can promote abortion, coupled with the fact that spontaneous early pregnancy loss is common, and litigation is increasing. This case report describes the circumstances that lead to the author using deep paraspinal and periosteal acupuncture throughout a patient's pregnancy to help control her low back pain.
Acupuncture in medicine : journal of the British Medical Acupuncture Society, 2011
It has been suggested that acupuncture may pose particular risks during pregnancy: by enhancing o... more It has been suggested that acupuncture may pose particular risks during pregnancy: by enhancing oxygenation to the developing embryo (presumably via increasing blood flow to the uterus); by affecting the level of maternal progesterone in early pregnancy; or by stimulating uterine contractions. This article examines the proposed risks and fails to find any plausible physiological mechanism for them.
Acupuncture in medicine : journal of the British Medical Acupuncture Society, 2013
Obesity is one of the leading health risk factors worldwide and is associated with several other ... more Obesity is one of the leading health risk factors worldwide and is associated with several other risk factors and health problems including type 2 diabetes mellitus, cardiovascular disease and malignancies. Current conventional therapeutic strategies for obesity cannot achieve adequate weight control in all patients, so complementary types of treatment are also performed. Acupuncture, one of the oldest healing practices, represents the most rapidly growing complementary therapy which is recognised by both the National Institutes of Health and the WHO. A previous review concluded that acupuncture was superior to lifestyle advice, to sham acupuncture and to conventional medication. In this narrative review, the possible mechanisms of actions and the results of recent experimental and clinical studies with different forms of acupuncture (eg, body, auricular, manual and electroacupuncture) are presented. In particular, the effects of acupuncture on anorexigenic and orexigenic peptides, insulin resistance, lipid metabolism and inflammatory markers are discussed. Both experimental and clinical current data suggest that acupuncture exerts beneficial effects on the mechanisms of obesity. Some data suggest that electroacupuncture may be more effective than manual acupuncture; however, the most effective frequency remains controversial. Combination of different forms of acupuncture with diet and exercise seems to be necessary for achieving and maintaining weight loss. Further prospective clinical trials are needed to establish the effectiveness of this complementary method for obesity treatment.
Complementary and alternative medicine (CAM) is frequently used in patients in industrialised cou... more Complementary and alternative medicine (CAM) is frequently used in patients in industrialised countries. Despite this popularity, there remains a considerable deficit of discourse and cooperation between physicians practicing CAM and conventional medicine. The aim is to present the methodology and results of the first international case conference on integrative medicine (IM) dealing with a patient with low back pain. In this paper the methodological tool "case conference on IM" is also described. The interactive case conference took place on November 20th, 2009 as part of the "2nd European Congress of IM" in Berlin, Germany. An experienced expert panel from both conventional medicine and CAM developed integrative medical diagnoses and therapeutic strategies using as their starting point an individual patient case on chronic low back pain (LBP). The case was selected because LBP is a common diagnosis with considerable economic impact and a problem which is often treated with CAM. In this case conference, the expert panel agreed on a diagnosis of "chronic non-specific LBP with somatic and psychological factors" and proposed multi-modal short- and long-term treatment including of CAM. The importance of the patient-physician-relationship and the consultation process with appropriate consultation time for treatment success was highlighted. There was consensus that the diagnostic process and resulting treatment plan should be individualised and focussed on the patient as a complete person, identifying the significance the disease has for the patient and not just on the disease for itself. Considerable differences were found amongst the experts regarding the first steps of treatment and each expert saw possibilities of "effective and adequate treatment" being met by their own individual treatment method. The case conference on integrative medicine stimulated an intensive exchange between the approaches used by conventional medicine and CAM clarifying different treatment possibilities for low back pain. Therefore, case conferences on integrative medicine could serve as a model for evaluating similar activities in academic hospitals and establishing such approaches in routine medical care. This strategy has the potential to improve patient centred care.
ABSTRACT Acupuncture is increasingly popular, and Woo and colleagues correctly emphasise the need... more ABSTRACT Acupuncture is increasingly popular, and Woo and colleagues correctly emphasise the need to increase awareness of its side effects and for training and regulation.1But the risk of infection is overstated because the editorial is based largely on anecdotal evidence: a 33 year old review, four case reports, a retrospective case series, and one epidemiological study from South Korea. It …
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Papers by Mike Cummings