March 2008
Conference: 3rd International Congress on Complementary Medicine Research
At: Sydney, Australia
Project: Acupuncture
Aims
The aim of this exploratory, pragmatic randomised controlled trial was to investigate the effectiveness of traditional Chinese acupuncture (TCA), using an individually targeted treatment protocol delivered by a traditionally trained Chinese acupuncturist. The trial examined the treatment of chronic stress as perceived and reported by the participants, with all its diversity of presenting symptoms, rather than using a cohort approach based on a single stress-related symptom.
Methods
Participants (n = 18) with high self-reported stress levels were randomised into 3 groups. Group 1 received weekly TCA for 5 weeks; group 2 received weekly attention only (practitioner present and participant supine) for 5 weeks and group 3 acted as a waiting list control. The Perceived Stress Scale 14 (PSS-14) and the Measure Yourself Medical Outcome Profile (MYMOP) were completed before and after a 5-week intervention.
Results
After 5 weeks, group 1 reported significant changes in MYMOP profile score and both MYMOP reported symptoms (p < 0.05); group 2 had significant changes in MYMOP profile score and 1 symptom (p < 0.05); group 3 showed no changes. The PSS-14 scores decreased in all 3 groups, but the difference between pre- and post-study within and between the groups did not reach significance in this small study. In addition, there were self-reports of improvements for group 1 for other health problems encountered during treatment.
Limitations and conclusions
The lack of clarity concerning the definition of stress makes it complex to investigate. This pilot study suggests that TCA may be successful in treating the symptoms of stress, through a combination of specific and non-specific effects; but may not relate directly to how a person perceives their stress.
Introduction
Stress is a physical and psychological response to perceived demands and pressures.1 Research has demonstrated that stress has a high cost to an individual’s health and well-being and their productivity in the workplace.2 If stress-related symptoms are left untreated chronic conditions can develop and subsequently lead to serious illness, such as coronary heart disease, hypertension, diabetes and cancer.3, 4 The World Health Organisation estimates that mental health problems, including stress-related disorders, will become the second most common cause of disability by 2020.5
People suffering from stress can present with a variety of conditions, posing problems for a conventional practitioner to treat on a symptomatic basis. A survey of UK general practitioners suggested that stress constitutes an “effectiveness gap” or an area of clinical practice in which available treatments are not fully effective.6 The suppression of symptoms without treatment of the underlying stressors can lead to repeated visits to healthcare practitioners, with recurring or varying conditions. Stress management techniques can be used to help people identify their stressors and make behavioural changes to prevent the onset of symptoms, but are less effective at treating chronic conditions once symptoms begin to manifest themselves. Successful treatment of stress-related illness requires an approach that aims to improve general well-being, encourages positive behavioural changes and improves presenting symptoms in order to prevent stress from developing into chronic ill health.
Acupuncture, well established in China as part of Traditional Chinese Medicine, is increasingly popular in western society.7 The symptoms reported for people presenting for acupuncture treatment are often those related to stress. A descriptive study of the practice of chartered physiotherapists using acupuncture in the UK showed stress to be one of the conditions perceived to respond well to this approach.8 The authors recommended this topic as an area for future research.
The complexity of stress and its management suggests that acupuncture research often aims to simplify study design by restricting the points used in a manner that bears no resemblance to actual clinical practice9 or that it focuses on a single stress-related symptom.10 Traditional Chinese Acupuncture (TCA) has a holistic approach. Its traditional theories of zang and fu organs and the seven emotions provided a framework thousands of years ago for understanding how a bad environment or disturbed mental state is closely connected with disease. Therefore, symptoms of stress and treatment theory have been an integral part of ancient Chinese Medicine.
This study took a pragmatic approach, investigating traditional acupuncture in the form most frequently used in a complementary setting, with an individually targeted treatment protocol and an unrestricted use of practitioner skills within the intervention. It aimed to investigate the treatment of chronic stress as perceived and reported by the participant, with all its diversity of presenting symptoms, rather than restricting the study to those reporting a single symptom which may or may not be an indicator of stress. The outcome measures were chosen to enable the exploration of the health changes and perceptions of a small group of participants with relatively stable, self-reported, chronic stress.
This study also aimed to pilot a trial design which could be used more widely for research into complementary medicine where there is a need to combine a pragmatic approach, reflecting clinical practice, with the need for a design to help define the boundaries of specific and non-specific effects of treatment.
The research question for this study is if TCA would demonstrate the improvement of perceived stress and its symptoms after 5 sessions of treatment.