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Aaron Scott
Aaron Scott

Download Atlas Acupuncture

Written by one of the world's leading experts on Western auriculotherapy, Ear Acupuncture -- now in a fullyupdated Second Edition -- provides readers with succinct descriptions ofacupuncture points and practical advice on how to incorporate ear acupuncturetreatment strategies and techniques into daily practice.

Download Atlas Acupuncture


A flexi textbook that contains information on all the major body and ear acupuncture points, as well as an extensive coverage of trigger points. The text is augmented by 126 illustrations pertaining to body acupuncture, 48 illustrations on ear acupuncture, and 114 illustrations on trigger points. The description of each point includes:

Chronic neck pain is a common condition in the adult population. More research is needed to evaluate interventions aiming to facilitate beneficial long-term change. We propose to evaluate the effect of Alexander Technique lessons and acupuncture in a rigorously conducted pragmatic trial with an embedded qualitative study.

Participants will be randomised in equal proportions to Alexander Technique lessons, acupuncture or usual care alone. Twenty 30-minute Alexander Technique lessons will be provided by teachers registered with the Society of Teachers of the Alexander Technique and twelve 50-minute sessions of acupuncture will be provided by acupuncturists registered with the British Acupuncture Council. All participants will continue to receive usual GP care.

Our principal research question asks: What is the clinical and economic impact when comparing acupuncture treatment plus usual care to usual care alone, and Alexander Technique lessons plus usual care to usual care alone in patients with chronic neck pain who are recruited from primary care? We will also compare acupuncture to Alexander Technique lessons to estimate possible clinical differences. We will determine whether putative benefits are clinically worthwhile. We will compare the cost-effectiveness of the alternative strategies, and if these interventions are at an additional cost to usual care, then we will ascertain whether they are worth paying for in terms of cost per Quality Adjusted Life Year (QALY) gained, in the context of the National Institute for Health and Care Excellence (NICE) threshold, which ranges from 20,000 to 30,000 [5]. We will also assess the acceptability and safety profile of acupuncture and Alexander Technique lessons for this patient group. In this study, we have used our pilot trial on acupuncture for chronic neck pain (ISRCTN06223266) [6] to inform the design of the full-scale trial.

Acupuncture and Alexander Technique lessons are two interventions that are not widely provided within the NHS, yet have the potential to safely deliver longer term benefits for spine-related conditions. Both interventions involve individualised sessions that include support for sustained improvement in health, based on changes in self-care and/or lifestyle [7, 8]. Using pragmatic trial designs, where the trial practitioners can provide interventions similar to what they normally would provide in their routine care, long-term benefits have been observed in acupuncture at 12 and 24 months for headache and back pain respectively [9, 10]. Acupuncture was found to be cost-effective [11, 12]. A Medical Research Council funded trial of Alexander Technique lessons for back pain patients found long-term clinical and cost-effectiveness benefits at 12 months [13, 14].

NICE now recommends acupuncture as a referral option within primary care for people with persistent low back pain [15]. The clinical effectiveness and cost-effectiveness illustrated by our York-based trial [11] was central to that decision. The proposed trial has a similar design, and therefore the results will help to inform decision making by policy makers, providers and commissioners as well as patients. If it is found that either of these two interventions is not effective, then decisions to limit the use of these interventions within the NHS will also be in the interests of both the NHS and patients.

The study is a three-arm pragmatic randomised, controlled trial to evaluate the effectiveness, cost effectiveness, safety and acceptability of acupuncture and Alexander Technique lessons for patients with chronic neck pain. The three arms are: acupuncture plus usual care, Alexander Technique lessons plus usual care, and usual care alone. Participants will be recruited from primary care and randomised to one of the three arms after we have obtained their informed consent to participate in the trial and their completed baseline questionnaire and after they have been screened for eligibility.

Procedures used to identify, shortlist, and recruit Alexander Technique teachers and acupuncturists will be based on those procedures successfully employed in the ACUDep trial, which compared acupuncture, counselling and usual GP care for the treatment of depression (ISRCTN63787732) [20]. As a starting point we shall seek to identify geographical clusters of suitably qualified and experienced Alexander teachers and acupuncturists, who together would be capable of delivering both interventions to trial participants living in Northern England. Each geographical cluster should consist of no less than two Alexander teachers and two acupuncturists, ideally within a two-mile radius. However, additional consideration will be given to local issues relating to public transport and accessibility. Given that patients will be recruited from nearby general practices, most participants will live within walking distance of both an Alexander teacher and acupuncturist. This should serve to minimise any burden on participants in terms of travel, maximise attendance rates, and help to maintain equipoise between both intervention groups. Alexander teachers and acupuncturists who are shortlisted by the research team, and are willing to support the trial, will then be required to submit a curriculum vitae for review, together with any evidence for recent continuing professional development activities. This review process will be conducted in conjunction with relevant professional members of the trial management group. Alexander teachers and acupuncturists who are finally selected will need to provide evidence of professional indemnity insurance and undergo Criminal Records Bureau clearance.

All participants will remain under the care of their GP and will receive usual NHS treatments as well as other care throughout the trial. This is expected to include GP consultations, typically involving brief advice lasting perhaps 10 minutes per consultation plus the offer of prescribed painkillers. Some participants will also be taking over-the-counter medication and/or consult with NHS and non-NHS practitioners. We will record and measure the full range of what constitutes usual care that all participants continue to receive throughout the trial period. This will include additional acupuncture and Alexander Technique lessons, whether paid for out-of-pocket or provided free within the NHS.

Acupuncture and Alexander Technique lessons are relatively safe interventions. However we will involve all practitioners in an induction event prior to their providing sessions for participants within the trial. We will document the procedures designed to minimise the key risks and will induct practitioners into the trial documentation. For acupuncture, the current evidence is that the modality is very safe when practised by competent practitioners. Expected adverse events that have been associated with acupuncture include nausea, fainting, dizziness, sweating, vomiting, bruising, numbness and bleeding at the site of needling, stiffness, headache or migraine, sleeplessness, aggravation of existing symptoms, drowsiness or tiredness after treatment (which might be a concern if participants are driving home), diarrhoea, and emotional reactions, such as anxiety and panic [22, 23]. Likewise, for Alexander Technique lessons, the risks are very low as the manual aspects of the lessons involve guidance, not manipulation as generally understood, and are very gentle. Possible adverse events associated with Alexander Technique lessons include transient dizziness during a lesson, tiredness usually beginning 1 to 2 hours or more after a lesson, and muscle aches (similar to those post-exercise). For the population as a whole, expected hospital admissions might occur due to musculoskeletal injuries, cardiovascular disorders, gastrointestinal disorders, respiratory disorders, cancer-related care, exacerbation of existing medical conditions and elective surgery. We will use the standard operating procedures of the York Trials Unit for monitoring and reporting adverse events. Reporting on serious and non-serious adverse events will involve participants, practitioners and GPs.

People who are unable to speak or who find it difficult to communicate in English will be excluded from the study. A reasonable level of understanding of English is essential to engage in the sessions with an English-speaking practitioner, to sufficiently understand the practitioners who takes her/his case history, and to understand explanations of the acupuncture treatment or Alexander Technique lessons. No funds have been provided within the research grant to pay for the translation of materials into other languages or to cover costs associated with the use of interpreters, nor does the research team have established access to such services. Therefore while the translation of trial materials into other languages, or the use of interpreters, might enable a small number of patients who do not understand or speak English to take part in the study, in all likelihood this would be neither financially feasible nor practical.

The proposed trial will provide participants allocated to the offer of acupuncture a course of up to twelve 50-minute sessions, usually weekly initially and fortnightly towards the end of the series. We expect the acupuncture to be delivered within a five-month period. 041b061a72


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