CHIROPRACTIC EXCELLENCE

There are a lot of modalities available to complementary health care professionals nowadays, and many claim significant benefits and often share testimonials of miraculous results. Whenever I check out a new technique the first question I ask is “how does it work?” The answer needs to follow some kind of logical and plausible physiological principles before I even ask the second question; “is there any research?” I have to be honest that I struggle with web-sites and marketing materials that are full of claims and stories, but lacking in rationale and evidence. Auriculotherapy is one method that has continued to impress and excite me, and for this reason it is one of the primary modalities that I offer in my own practice. This is the third in a regular update of recent research.

First let’s summarise the most recent findings:

1) Satisfaction in a wellness clinic: This study involved feedback from health professionals being given access to wellness services including Auriculotherapy once a week in the workplace. Most participants agreed or strongly agreed they felt more relaxed after sessions (97.9%), less stress (94.5%), more energy (84.3%), and less pain (78.8%). Ninety-seven percent (97%) would recommend it to a co-worker. Among surveys completed after five or more visits, more than half (59%-85%) strongly agreed experiencing increased compassion with patients, better sleep, improved mood, and more ease in relations with co-workers. Perceived benefits were sustained and enhanced by number of visits.

2) Effects on autonomic function in healthy individuals: The results of this study using non-invasive assessment methods showed a significant decrease in heart rate, a significant increase in heart rate variability total, and marked (but statistically insignificant) decrease in pulse wave velocity. This translates to signs of decreased stress physiology internally.

3) Chronic low back pain: This pilot study found that Auriculotherapy was safe and demonstrated additional clinical benefits when combined with exercise for people with chronic low back pain. This supports my own observation that the best treatment for low back pain is a combination of passive and active treatment.

4) Effect on inflammatory reactions: This study using animals showed that Auriculotherapy can increase serum Tumour Necrosis Factor and Interleukin-6, and down-regulate pulmonary NF-kappa B p 65 expression suggesting a cholinergic anti-inflammatory mechanism. This suggests a neurological pathway for antiinflammatory effects of Auriculotherapy which makes sense since Auriculotherapy is a neurological intervention!

5) Treatment of migraine attacks: This study compared using a reflex point well documented to relieve migraine (group A) versus a point unlikely to have a therapeutic effect (group B). During treatment, there was a highly significant trend in the reduction of symptoms in group A, whereas no significance was observed in group B. Symptoms were significantly lower in group A than in group B at 10, 30, 60 and 120 min after treatment. This study suggests that the therapeutic specificity of auricular points exists and is linked to the somatotopic representation of our body on the ear.

6) Analgesia and sedative effects during abdominal gynecological operation and effects on postoperative recovery of body function: This showed sedative, analgesic and function-regulating effects from Auriculotherapy. Anxiety was less, lower-doses of anaesthesia were required, breathing response was improved after the operation, and higher levels of serum beta-endorphin were found when Auriculotherapy was added. Anything that potentially improves surgical outcomes sounds like a really good thing to me!

7) Improving postural stability: Balance performance was measured on a force platform before and after Auriculotherapy. Main balance parameters pointed to an average short-term improvement of about 15% 1 hour after treatment and 5-10% after an interval of 3 days. However, a few participants showed a better than 30% improvement with the same parameters. The explanation tentatively put forward to account for the results was that Auriculotherapy reduces nociceptive interference and thus improves postural control.

Treating headache, trigeminal neuralgia and retro-auricular pain in facial palsy: In this study Auriculotherapy treatment showed pain alleviation in headache, trigeminal neuralgia, and retro-auricular pain levels. The researchers noted that treatment number should be no less than 10 sessions.

9) Preoperative anxiety treatment: Preoperative anxiety has become more frequent in preoperative patients and can bring negative impact on operation outcomes. The study concluded that Auriculotherapy was significantly effective in decreasing anxiety in preoperative patients.

Sounds like some good reasons to check out Auriculotherapy training to me… Go to http://www.torquerelease.com.au/Auriculotherapy-Discount.htm to find out more…

Now for the abstracts:

1) Employee use and perceived benefit of a complementary and alternative medicine wellness clinic at a major military hospital: evaluation of a pilot program.

J Altern Complement Med. 2011 Sep;17(9):809-15. 2011 Aug 11. Duncan AD, Liechty JM, Miller C, Chinoy G, Ricciardi R.

Abstract Objectives: The objectives of this study were to examine the feasibility of a weekly on-site complementary and alternative medicine (CAM) wellness clinic for staff at a military hospital, and to describe employees’ perceptions of program effectiveness. Setting: The study setting was the Restore & Renew Wellness Clinic at a United States Department of Defense hospital. Subjects: The subjects were hospital nurses, physicians, clinicians, support staff, and administrators. Interventions: The walk-in wellness clinic was open 8:00am – 2:00pm 1 day a week. Participants selected one or more modalities each visit: ear acupuncture, clinical acupressure, and Zero Balancing. Outcome measures: A self-report survey was done after each clinic visit to evaluate clinic features and perceived impact on stress-related symptoms, compassion for patients, sleep, and workplace or personal relationships. Results: Surveys completed after first-time and repeat visits (n=2,756 surveys) indicated that most participants agreed or strongly agreed they felt more relaxed after sessions (97.9%), less stress (94.5%), more energy (84.3%), and less pain (78.8%). Ninety-seven percent (97%) would recommend it to a co-worker. Among surveys completed after five or more visits, more than half (59%-85%) strongly agreed experiencing increased compassion with patients, better sleep, improved mood, and more ease in relations with co-workers. Perceived benefits were sustained and enhanced by number of visits. The most frequently reported health habit changes were related to exercise, stress reduction, diet/nutrition, and weight loss. Conclusions: This evaluation suggests that a hospital-based wellness clinic based on CAM principles and modalities is feasible, well-utilized, and perceived by most participants to have positive health benefits related to stress reduction at work, improved mood and sleep, and lifestyle.

2) Brain-modulated effects of auricular acupressure on the regulation of autonomic function in healthy volunteers.

Evid Based Complement Alternat Med. 2011 Aug 29. Gao XY, Wang L, Gaischek I, Michenthaler Y, Zhu B, Litscher G.

Auricular acupuncture has been described in ancient China as well as Egypt, Greece, and Rome. At the end of the 1950s, ear acupuncture was further developed by the French physician Dr. Paul Nogier. The goal of this study was to develop a new system for ear acupressure (vibration stimulation) and to perform pilot investigations on the possible acute effects of vibration and manual ear acupressure on heart rate (HR), heart rate variability (HRV), pulse wave velocity (PWV), and the augmentation index (AIx) using new noninvasive recording methods. Investigations were performed in 14 healthy volunteers (mean age ± SD: 26.3 ± 4.3 years; 9 females, 5 males) before, during, and after acupressure vibration and manual acupressure stimulation at the “heart” auricular acupuncture point. The results showed a significant decrease in HR (P ≤ 0.001) and a significant increase in HRV total (P = 0.008) after manual ear acupressure. The PWV decreased markedly (yet insignificantly) whereas the AIx increased immediately after both methods of stimulation. The increase in the low-frequency band of HRV was mainly based on the intensification of the related mechanism of blood pressure regulation (10-s-rhythm). Further studies in Beijing using animal models and investigations in Graz using human subjects are already in progress.

3) Exercise and Auricular Acupuncture for Chronic Low-back Pain: A Feasibility Randomized-controlled Trial.

Clin J Pain. 2011 Jul 12. Hunter RF, McDonough SM, Bradbury I, Liddle SD, Walsh DM, Dhamija S, Glasgow P, Gormley G, McCann SM, Park J, Hurley DA, Delitto A, Baxter GD.

OBJECTIVES: To evaluate the feasibility of a randomized-controlled trial (RCT) investigating the effects of adding auricular acupuncture (AA) to exercise for participants with chronic low-back pain (CLBP).

METHODS: Participants with CLBP were recruited from primary care and a university population and were randomly allocated (n=51) to 1 of 2 groups: (1) “Exercise Alone (E)”-12-week program consisting of 6 weeks of supervised exercise followed by 6 weeks unsupervised exercise (n=27); or (2) “Exercise and AA (EAA)”-12-week exercise program and AA (n=24). Outcome measures were recorded at baseline, week 8, week 13, and 6 months. The primary outcome measure was the Oswestry Disability Questionnaire.

RESULTS: Participants in the EAA group demonstrated a greater mean improvement of 10.7% points (95% confidence interval, -15.3,-5.7) (effect size=1.20) in the Oswestry Disability Questionnaire at 6 months compared with 6.7% points (95% confidence interval, -11.4,-1.9) in the E group (effect size=0.58). There was also a trend towards a greater mean improvement in quality of life, LBP intensity and bothersomeness, and fear-avoidance beliefs in the EAA group. The dropout rate for this trial was lower than anticipated (15% at 6 mo), adherence with exercise was similar (72% E; 65% EAA). Adverse effects for AA ranged from 1% to 14% of participants.

DISCUSSION: Findings of this study showed that a main RCT is feasible and that 56 participants per group would need to be recruited, using multiple recruitment approaches. AA was safe and demonstrated additional benefits when combined with exercise for people with CLBP, which requires confirmation in a fully powered RCT.

4) Effect of electroacupuncture of auricular concha on inflammatory reaction in endotoxaemia rats.

Zhen Ci Yan Jiu. 2011 Jun;36(3):187-92. Zhao YX, He W, Gao XY, Rong PJ, Zhu B.

OBJECTIVE: To evaluate the effect of electroacupuncture (EA) of the auricular concha (EA-AC) on serum cytokines contents and pulmonary transcription factor nuclear factor-kappaB (NF-kappaB) expression in lipopolysaccharide (LPS) induced endotoxaemia rats so as to study its mechanism underlying cholinergic anti-inflammatory efficacy.

METHODS: Male SD rats were randomized into normal control, model (LPS), simple EA-AC, EA-AC + LPS, vagal nerve stimulation (VNS) + LPS, and EA-Zusanli (ST 36) + LPS groups (n = 12/group). Endotoxaemia model was duplicated by intravenous (tail vein) injection of LPS (0.5 mL/kg). Two intradermal needles were inserted into the central sites of the cavity of concha and cymba of auricular concha respectively on each side and stimulated electrically by using an electrical stimulator (i.e, EA-AC). VNS was applied to the left cervical vagal nerve, and EA (1 mA, 10 Hz, pulse-width 1 ms) was also applied to bilateral “Zusanli” (ST 36). Serum cytokines (TNF-alpha IL-6) contents 2 h after modeling were determined by using enzyme linked immunosorbent assay (ELISA), and pulmonary NF-kappaB p 65 expression 2 h after modeling was detected by using western blotting.

RESULTS: Compared with the normal control group, serum TNF-alpha and IL-6 contents, and pulmonary NF-kappaB p65 expression level in the model group were increased significantly (P < 0.01). In comparison with the model group, serum TNF-alpha contents in the simple EA-AC, EA-AC + LPS, VNS+ LPS and ST 36 + LPS groups, and serum IL-6 contents and pulmonary NF-kappaB p 65 expression levels in the simple EA-AC, EA-AC + LPS and VNS + LPS groups were down-regulated considerably (P < 0.05, P < 0.01). Compared with the VNS + LPS group, serum TNF-alpha -28) and IL-6 contents, and pulmonary NF-kappaB p 65 expression level in the ST 36 + LPS group were increased significantly (P < 0.05, P < 0.01). In comparison with the EA-AC + LPS group, pulmonary NF-kappaB p 65 expression level in the ST 36 + creased remarkably (P < 0.05).

CONCLUSION: Both EA of auricular concha and vagus nerve stimulation can increase serum TNF-alpha and IL-6 contents, and down-regulate pulmonary NF-kappaB p 65 expression level in endotoxaemia similar cholinergic anti-inflammatory mechanism between them.

5) Ear acupuncture in the treatment of migraine attacks: a randomized trial on the efficacy of appropriate versus inappropriate acupoints.

Neurol Sci. 2011 May;32 Suppl 1:S173-5. Allais G, Romoli M, Rolando S, Airola G, Castagnoli Gabellari I, Allais R, Benedetto C.

Ear acupuncture can be a useful mean for controlling migraine pain. It has been shown that a technique called the Needle Contact Test (NCT) can identify the most efficacious ear acupoints for reducing current migraine pain through just a few seconds of needle contact. The majority of the points were located on the antero-internal part of the antitragus (area M) on the same side of pain. The aim of this study was to verify the therapeutic value of area M and to compare it with an area of the ear (representation of the sciatic nerve, area S) which probably does not have a therapeutic effect on migraine attacks. We studied 94 females suffering from migraine without aura, diagnosed according to the ICHD-II criteria, during the attack. They were randomly subdivided into two groups: in group A, tender points located in area M, positive to NCT were inserted; in group B, the unsuitable area (S) was treated. Changes in pain intensity were measured using a VAS scale at various times of the study. During treatment, there was a highly significant trend in the reduction of the VAS value in group A (Anova for repeated measures: p < 0.001), whereas no significance was observed in group B. VAS values were significantly lower in group A than in group B at 10, 30, 60 and 120 min after needle insertion. This study suggests that the therapeutic specificity of auricular points exists and is linked to the somatotopic representation of our body on the ear.

6) Effects of magnetic auricular point-sticking on adjuvant anesthesia and postoperative recovery of body function.

Zhongguo Zhen Jiu. 2011 Apr;31(4):349-52. Li WS, Cui SS, Li WY, Zhao WX, Wanlai SQ.

OBJECTIVE: To prove analgesia and sedative effect of adjuvant anesthesia with magnetic auricular point-sticking on abdominal gynecological operation and its effect on postoperative recovery of body function.

METHODS: Ninety-two patients with abdominal gynecological operation were randomly divided into 3 groups. The auricular point-sticking group (APS group, n=31) was pasted and pressed by plasters with magnetic beads at bilateral Shenmen, Pizhixia (subcortex), Zigong (uterus) and Penqiang (pelvic cavity), etc. the night before operation. The placebo group (n=31) was pasted by plasters without magnetic beads. The blank group (n=30) was given no intervention. The mental and gastrointestinal functional changes before and 3 days after the operation were observed.

RESULTS: As compared with those in the control group and the blank group, the postoperative score of Self rating Anxiety Scale (SAS) was less (25.5 +/- 0.81 vs. 28.9 +/- 3.19, 28.3 +/- 2.36, both P < 0.01), with lower-dose of Innovar [(2.5 + 1.1) mL vs. (3.4 + 1.8) mL, (3.2 + 1.6) mL, both P < 0.05], earlier exsufflation after the operation [(34.2 + 12.1) h vs. (46.3 + 10.9) h, (43.2 + 14.8) h, both P < 0.01] and higher level serum of beta-endorphin before and after the operation in the APS group (all P < 0.05).

CONCLUSION: The magnetic auricular point-sticking has sedative, analgesic and function-regulating effects on the abdominal gynecological operation.

7) Laser acupuncture and auriculotherapy in postural instability – a preliminary report.

J Acupunct Meridian Stud. 2011 Mar;4(1):69-74. Bergamaschi M, Ferrari G, Gallamini M, Scoppa F.

The risk of falling is rather high among elderly people. Indexes obtained through the Romberg stabilometric test on a force platform have been suggested to be correlated with the risk of falling. This work aimed to test the effectiveness of auriculopuncture and ultralow-power laserpuncture versus placebo (sham stimulation) in improving postural control in an elderly population. Balance performance was measured on a force platform before and after both forms of stimulation. Main balance parameters pointed to an average short-term improvement of about 15% 1 hour after treatment and 5-10% after an interval of 3 days. However, a few participants showed a better than 30% improvement with the same parameters. Although the sample size does not allow reliable statistical analysis, the modifications are remarkable and some differences are observed between the two kinds of stimulation. Further testing with larger sized groups and including one further group using both stimulations is suggested. Although postural instability has to be defined as multi-factorial, it is often associated with balance dysfunctions that cannot be related to vestibular or central impairments but rather to proprioceptive deficits. A significant role may be ascribed to (even subliminal) nociceptive interferences with proprioceptive inputs and to a reduced capacity for updating cortical motor control models in the case of progressively declining locomotor capabilities. The explanation tentatively put forward to account for the results observed in the present preliminary study is that laser acupuncture and auriculopuncture stimulations reduce nociceptive interference and thus improve postural control.

A clinical pilot study comparing traditional acupuncture to combined acupuncture for treating headache, trigeminal neuralgia and retro-auricular pain in facial palsy.

J Acupunct Meridian Stud. 2011 Mar;4(1):29-43. Ahn CB, Lee SJ, Lee JC, Fossion JP, Sant’Ana A.

Traditional acupuncture (TA) and ear acupuncture (EA) are used for treatment of headache, trigeminal neuralgia, and retro-auricular pain. The purpose of this study is to develop effective treatment using combined acupuncture (CA) which consists of TA and EA and to set clinical protocols for future trials. Participants were divided into TA (n = 15) control and CA (n = 34) experimental groups. Obligatory points among Korean Five Element Acupuncture and optional individual points along with symptom points were used in the TA group. The CA group was exposed to ear points of Fossion and TA. Acupuncture treatment consisted of six mandatory sessions per patient over 3 weeks and extended to 12 sessions. Pain was assessed using the visual analogue scale. We compared TA to CA and researched their relevant publications. No significant difference was observed between the two groups (p = 0.968) which showed pain-alleviating tendency. Pain alleviation was significantly different after the fifth and sixth sessions (p = 0.021, p = 0.025), with headache being the most significantly relieved (F = 4.399, p = 0.018) among the diseases. When assessing pain intensity, both the Headache Impact Test and the Migraine Disability Assessment Scale should be adopted for headache and the fractal electroencephalography method be used in pain diseases. In the future, studies should consist of TA, EA, and CA groups; each group having 20 patients. Treatment number should to be no less than 10 sessions. Korean Five Element Acupuncture should be a compulsory inclusion along with individual points being optional inclusion in TA. EA could be selected from Nogier, Fossion and so forth. In conclusion, acupuncture treatment, whether TA or CA, showed pain alleviation in headache, trigeminal neuralgia, and retro-auricular pain, but no significant difference was seen between groups. Prospective, well-controlled, and relevant protocols using multimodal strategies to define the role of TA, EA, and CA are needed.

9) Comparing the treatment effectiveness of body acupuncture and auricular acupuncture in preoperative anxiety treatment.

J Res Med Sci. 2011 Jan;16(1):39-42. Wu S, Liang J, Zhu X, Liu X, Miao D.

BACKGROUND: Preoperative anxiety has become more frequent in preoperative patients and can bring negative impact on operation outcomes. Many studies have reported the effect of body acupuncture in reducing anxiety syndromes. The aim of this study is to compare the treatment effect of body acupuncture and auricular acupuncture in preoperative patients with preoperative anxiety.

METHODS: Thirty five elective ambulatory surgery patients were selected in the randomized and blinded trial. Subjects were randomly categorized in two intervention groups, the body acupuncture group who received acupuncture in the special points of body, and the auricular acupuncture group who received ear acupuncture. Zung Self-Rating Anxiety Scale (SAS) was used before and after the study.

RESULTS: For the auricular acupuncture group, the mean score of SAS was 57.57 ± 8.22 before the intervention and 46.32 ± 6.37 afterward. For the body acupuncture group, the SAS score was 55.39 ± 5.41 and 44.82 ± 6.76 before and after the intervention, respectively. For both groups, the difference between pre- and post-treatment scores reached the significant level (p = 0.00).

CONCLUSIONS: Both auricular and body acupuncture treatment methods were effective in decreasing anxiety in preoperative patients.

Sounds like some good reasons to check out Auriculotherapy training to me… Go to http://www.torquerelease.com.au/Auriculotherapy-Discount.htm to find out more…

1. Speeds up your decision making – provides an extremely fast assessment process that delivers absolute certainty that you are adjusting each client exactly where they need to be adjusted on each and every visit.
2. Is so much easier on their own bodies – are you paying a personal physical and emotional price for the healing that you provide to others? Why not upgrade to a new-generation technique that is easy on your body and mind?
3. Provides an extremely effective low-force adjusting strategy – If you are like me, you may have steered away from instrument and low-force adjusting because you perceive it to be inferior to manual adjusting. The Integrator actually provides you with specifications that surpass manual adjustment – higher speed, greater specificity, recoil and torque, pre-loading mechanism to make every adjustment reproducible and consistent, exact correctional vectors, true adjustment for force, can deliver adjustments with spine in neutral posture to reduce iatrogenic risks.
4. Helps make the quantum shift to a neurologically-based system – You may think in your own mind, that when you produce a cavitation in your practice members’ subluxated spine, that you are releasing the flow of the mental impulse: But in most of your patient’s minds, they think you are cracking their back to stretch their stiff and sore bones… This is a sad but true fact about public perception. But, the good news is that when you shift to an assessment process which utilises neurological indicators, and adjust with an instrument that has been designed to initiate neurological change; it becomes so much easier to shift your practice members’ understanding to the fact that you are a nerve doctor, and not a back doctor.
5. Allows them to see more clients in less time – Speed up your assessment and clinical decision making, reduce the number of adjustments you perform on each visit, cut back on the extra stuff that you do out of habit as opposed to clinical necessity – All this translates to increased productivity and profitability, and decreased time wastage and brain drain.
6. Opens up your practice world to the emotional component of Subluxation – You don’t have to become a counsellor, but when more of your clients experience emotional, mental and even spiritual change following their adjustments, they’ll want to tell you about it. They’ll also want to tell their friends, family and colleagues about it; and usually what happens in a TRT practice is you become inundated with folks desiring and experiencing the same changes.
7. It fits snugly into a wellness paradigm - Chiropractic has succeeded in positioning its identity in the community: The average person on the street, the local GP, other health care professionals, and your local media all think you treat sore backs reasonably effectively, and then try to keep them coming back for no particular reason. If you want to reposition yourself as a “wellness” provider then you are going to have to appear very different; and your “product” or “unique selling proposition” needs to appear cutting-edge, exciting and modern. TRT fulfils all of these criteria – you’ll actually find your practice members asking “I know this is really great for my total health and energy, and I don’t seem to get sick very often anymore, but if I develop a sore back should I still come and see you, or should I go to one of those old-style chiros?”
8. It’s actually becomes easy to write a case study – Because the protocols of TRT analysis are well documented and consistent, because you learn neurological indicators that can be documented and even quantified, and because you seem to attract more diverse clinical presentations, most DCs find themselves having a steady stream of cases that can easily be written up and published.