PAINÒ 152 (2011) 2399–2404 Validity of four pain intensity rating scales Maria Alexandra Ferreira-Valente , José Luís Pais-Ribeiro , Mark P. Jensen a Faculdade de Psicologia e Ciências da Educação da Universidade do Porto, Porto, Portugalb Portuguese Foundation for Science and Technology, Lisbon, Portugalc Unidade de Investigação em Psicologia e Saúde (Psychology and Health Unit), Lisbon, Portugald Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
Microsoft word - acne november 2014.docxACUPUNCTURE AND ACNE
Acne vulgaris, the most common type of acne, is a chronic inflammatory skin
disease affecting hair follicles, and sebaceous glands and ducts. It occurs on
the face in 99% of those affected and, less often, on the back and
chest.(Layton 2010) Characteristic features include overproduction of sebum
(seborrhoea); thickening of the follicle stratum corneum, which can lead to
blockage and accumulation of sebum to form non-inflamed lesions called
comedones; colonisation of the pilosebaceous ducts by Propionibacterium
acnes; and inflamed lesions (e.g. papules, pustules, inflamed nodules, pus-
filled cysts) that may be superficial or deep.(Layton 2010; Garner 2003)
Scarring can result from abnormal wound healing following inflammatory
damage.(Layton 2010) Acne conglobata is an uncommon and unusually severe
form of acne characterised by burrowing and interconnecting abscesses and
In the UK, around 15 per 1,000 people have acne.(Schofield 2009) The condition usually starts in adolescence and frequently resolves by the mid-20s.(Layton 2010) Severe disease can persist for 12 years or longer.(Layton 2010) Acne can have an impact on psychological well-being.(Schofield 2009; Smithard 2001) The exact cause of acne is unknown, but androgen secretion is the major trigger for adolescent acne. Conventional treatments include topical products containing azelaic acid or benzoyl peroxide for mild acne, topical or oral antibiotics, topical or oral retinoids and, for women, pills containing anti-androgens (eg Dianette). References
Garner SE. Acne vulgaris. In: Williams H (Ed). Evidence Based Dermatology.
London: BMJ, 2003.
Layton A. Disorders of the sebaceous glands. In: Burns DA et al (Eds). Rook's
Textbook of Dermatology. Eighth edition. London: Blackwell Publishing, 2010.
Schofield JK et al. Skin conditions in the UK: a health care needs assessment.
First edition. Nottingham: Centre of Evidence Based Dermatology, 2009.
Smithard A et al. Acne prevalence, knowledge about acne and psychological
morbidity in mid-adolescence: a community-based study. Br J Dermatol 2001;
Strauss JS et al. Guidelines of for acne vulgaris management. J Am Acad
Dermatol 2007; 56: 651–63.
Webster GF. Acne vulgaris: state of the science. Arch Dermatol
1999; 135: 1101–2.
How acupuncture can help Evidence pooled together in a systematic review has shown that acupuncture plus moxibustion is safe and effective for the treatment of acne, and possibly better than routine western medicine.(Li 2009) (see Table below) In one randomised controlled trial, acupuncture treatment of moderate acne vulgaris was associated with reduction of inflammatory lesions and improvement of the quality of life, but there was no non-acupuncture control for comparison (Son 2010). In another, adding warming moxibustion to a baseline acupuncture treatment improved the outcomes similarly to that of adding the drug isotretinoin(Mi 2010). Finally, one trial found body acupuncture to have some effect in the treatment of acne vulgaris, and that the addition of laser auricular irradiation may improve efficacy (Lihong 2006). There is very little research on acupuncture and acne outside of China. Most of the trials to date are of low quality and the conclusions of the systematic review should be viewed in that light. In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress (Hui 2010) Acupuncture may help to treat acne through one or more of the following general mechanisms, but as yet we have no specific information from studies on people with acne: • immunomodulatory factors (Zijlstra 2003; Kavoussi 2007); enhancing natural killer cell activities and modulating the number and ratio of immune cell types (Kawakita 2008); increasing local microcirculation (Komori 2009), which aids dispersal of swelling; About traditional acupuncture Acupuncture is a tried and tested system of traditional medicine, which has been used in China and other eastern cultures for thousands of years to restore, promote and maintain good health. Its benefits are now widely acknowledged all over the world and in the past decade traditional acupuncture has begun to feature more prominently in mainstream healthcare in the UK. In conjunction with needling, the practitioner may use techniques such as moxibustion, cupping, massage or electro-acupuncture. They may also suggest dietary or lifestyle changes. Traditional acupuncture takes a holistic approach to health and regards illness as a sign that the body is out of balance. The exact pattern and degree of imbalance is unique to each individual. The traditional acupuncturist's skill lies in identifying the precise nature of the underlying disharmony and selecting the most effective treatment. The choice of acupuncture points will be specific to each patient's needs. Traditional acupuncture can also be used as a preventive measure to strengthen the constitution and promote general well-being. An increasing weight of evidence from Western scientific research (see overleaf) is demonstrating the effectiveness of acupuncture for treating a wide variety of conditions. From a biomedical viewpoint, acupuncture is believed to stimulate the nervous system, influencing the production of the body's communication substances - hormones and neurotransmitters. The resulting biochemical changes activate the body's self-regulating homeostatic systems, stimulating its natural healing abilities and promoting physical and emotional well-being. About the British Acupuncture Council With over 3000 members, the British Acupuncture Council (BAcC) is the UK's largest professional body for traditional acupuncturists. Membership of the BAcC guarantees excellence in training, safe practice and professional conduct. To find a qualified traditional acupuncturist, contact the BAcC on 020 8735 0400 or visit www.acupuncture.org.uk ACUPUNCTURE AND ACNE
Li B et al. Evaluation of therapeutic A review that evaluated the therapeutic effect and safety of effect and safety for clinical acupuncture and moxibustion for the treatment of acne, and to randomized and controlled trials of analyse the current situation of clinical studies at present. treatment of acne with acupuncture Seventeen papers, including 1,613 patients, were included and and moxibustion. Zhongguo Zhenjiu all adopted the cured rate as the evaluation index, Meta-analysis [Chinese] 2009; 29: 247-51. comparing treatment of acne by acupuncture plus moxibustion with routine western medicine as a control found acupuncture to be more effective [combined relative risk 2.96, 95% CI 1.63 to 4.91; p<0.0001]. The researchers concluded that acupuncture plus moxibustion is safe and effective for the treatment of acne, and possibly better than routine western medicine. Randomised controlled
Son BK et al. Efficacy of ah shi point A double-blind randomised placebo-controlled trial that acupuncture on acne vulgaris. evaluated the efficacy of ah shi (painful) point and general Acupuncture in medicine 2010; 28: acupuncture point treatment of moderate acne vulgaris in 36 patients. Patients were evaluated using the following outcome measurements: an inflammatory lesion count, a quality-of-life scale (Skindex-29) and a subjective symptom score. After 12 treatment sessions, there was a significant reduction in the inflammatory acne lesion counts, the Skindex-29 scores and the subjective symptom scores from baseline in both groups, but no significant difference between groups. The researchers concluded that acupuncture treatment of moderate acne vulgaris was associated with reduction of inflammatory lesions and improvement of the quality of life. Mi JP, Yu ZS. Clinical observation of A randomised controlled trial that assessed the clinical efficacy cystic acne treated with warming of warming moxibustion on cystic acne in 94 patients. The basic moxibustion. Zhongguo Zhen Jiu treatment of body acupuncture combined with fire needling was [Chinese] 2010; 30: 383-6. applied in all of three groups. In the observation group, cone moxibustion was added to specific points (CV 4, CV 6, BL 20). In control group 1, oral isotretinoin was given in addition to acupuncture, and in control group 2, no additional therapy was given. After treatment, the total effective rate was 84.4% (27/32) in the observation group, 71.0% (22/31) in control group 1 and 51.6% (16/31) in control group 2. Both for total effective rate and for improvement in skin lesions the observation group was superior to control group 2 (p<0.05), but not significantly different to control group 1 (p>0.05). The researchers concluded that warming moxibustion can improve the efficacy of body acupuncture and fire needling on cystic acne, and it is equal in efficacy to isotretinoin. Lihong S. He-Ne laser auricular A randomised controlled trial that observed the therapeutic irradiation plus body acupuncture for effects of laser auricular irradiation plus body acupuncture for treatment of acne vulgaris in 36 acne vulgaris in 68 patients. The test treatment was compared cases. J Tradit Chin Med 2006; 26: with body acupuncture only. The results showed that the cure rate was 77.8% in the treatment group and 46.9% in the control group (p<0.05). The researchers concluded that the addition of laser auricular irradiation to body acupuncture may improve efficacy in the treatment of acne vulgaris. Research on mechanisms
Hui KK et al. Acupuncture, the limbic A paper that discusses research showing that acupuncture system, and the anticorrelated mobilises the functionally anti-correlated networks of the brain to networks of the brain. Auton Neurosci mediate its actions, and that the effect is dependent on the 2010; 157: 81-90. psychophysical response. The research used functional magnetic resonance imaging studies of healthy subjects to show that acupuncture stimulation evokes deactivation of a limbic-paralimbic-neocortical network, which encompasses the limbic system, as well as activation of somatosensory brain regions. It has also been shown that the effect of acupuncture on the brain is integrated at multiple levels, down to the brainstem and cerebellum. Komori M et al. Microcirculatory Experimental study on rabbits in which acupuncture stimulation responses to acupuncture was directly observed to increase diameter and blood flow stimulation and phototherapy. velocity of peripheral arterioles, enhancing local Anesth Analg 2009; 108: 635-40. microcirculation. Kawakita K et al. Do Japanese style A review of research into the effects of Japanese style acupuncture and moxibustion reduce acupuncture and moxibustion on the symptoms of the common symptoms of the common cold? cold. It reports that research has shown acupuncture to reduce eCAM 2008; 5: 481–9. common cold symptoms, and that acupuncture stimulation enhances natural killer cell activities and modulates the number and ratio of immune cell types. Kavoussi B, Ross BE. The Review article that suggests the anti-inflammatory actions of neuroimmune basis of anti- traditional and electro-acupuncture are mediated by efferent inflammatory acupuncture. Integr vagus nerve activation and inflammatory macrophage Cancer Ther 2007; 6: 251-7. Zijlstra FJ et al. Anti-inflammatory An article that suggests a hypothesis for anti-inflammatory actions of acupuncture. Mediators action of acupuncture: Insertion of acupuncture needles initially Inflamm 2003; 12: 59-69. stimulates production of beta-endorphins, CGRP and substance P, leading to further stimulation of cytokines and NO. While high levels of CGRP have been shown to be pro-inflammatory, CGRP in low concentrations exerts potent anti-inflammatory actions. Therefore, a frequently applied 'low-dose' treatment of acupuncture could provoke a sustained release of CGRP with anti-inflammatory activity, without stimulation of pro-inflammatory cells. Terms and conditions
The use of this fact sheet is for the use of British Acupuncture Council members and is subject to the strict conditions imposed by the British Acupuncture Council details of which can be found in the members area of its' website www.acupuncture.org.uk.
THREATENING Developed by: Becky Neff, RN & Becky Adams, RN using OSPI's Guidelines for Care of Students with Anaphylaxis (2009) Food allergy overview Emergency Medication What is your role? Signs and symptoms Increasing numbers of children (6-8%) are diagnosed with life-threatening food allergies that may potentially life- A reaction can occur within