Monday, February 7, 2011

Acupuncture Interns Participate in NIH Research Project

Over the past two years, students from the Acupuncture Program have participated in a National Center for Complementary and Alternative Medicine (NCCAM) study being conducted at Montefiore Family Health Center (MFHC). Researchers are conducting a feasibility study looking at whether acupuncture can help alleviate chronic pain when used within a family practice setting. Though the study is due to end during the summer of 2011, preliminary data is expected to be published in an alternative medicine journal early next year.

To qualify for the study, participants have to have chronic pain due to osteoarthritis, back pain or neck pain.  Two hundred and fourteen patients are enrolled, and four sites are involved. Swedish Institute students were the first acupuncture interns to start seeing patients at an MFHC location in the Bronx. Several months later other sites were added, and they are staffed by acupuncture students from Pacific College of Oriental Medicine.

Study Design
Giselle Campos, research coordinator at the MFHC site, says that the study is a mixed method design. “Data will come from patients, medical practitioners and the acupuncture interns who are providing treatments every week,” she said. “Patients were surveyed about the nature and intensity of their pain at the beginning of the study, and are being followed up throughout the study and afterwards.

“Supervising physicians will monitor the patients during their regular visits and note any medical changes, such as a reduction or increase in pain medication and services. Patients are advised not to change their medication use unless the physician advises them to do so.”
During their four-hour shift, interns typically see three or four patients. They assess each patient and document patient perception of pain based on a numerical scale and provide their own clinical impressions of any changes in the patient. Findings are written in SOAP (Subjective, Objective, Assessment and Plan) notes, which include energetic evaluations of the pulse and tongue.

For instance, in one patient with severe arm pain, the intern and supervising acupuncturist agreed that in addition to the issue of pain, an energetic issue needed to be addressed. Supervising acupuncturist Wendy Whitman, LAc, pointed out that, “For this patient we have to needle locally and distally for pain, but we also need to address ‘Shen disturbance’, which is a way of looking at the emotional issues. Because in this case the person will not get better without treating the emotions.” Points selected for the patient that day included Heart 7, to help with sleep, Bladder 15, the Heart Shu point important for calming and soothing, and Spleen 6 to nourish blood.

A Change in Perspective
Wendy participated in early research studies on acupuncture conducted in the 1980’s. She was part of a CPCRA (Community Programs for Clinical Research on AIDS) study at Harlem Hospital and an NIH study on drug addiction at Metro-Dade Country drug treatment facilities in Florida. She says she has witnessed an important evolution in the way acupuncture is being studied today.

“In earlier studies, we didn’t have the freedom to create a model that was in the normal paradigm of Chinese medicine,” Wendy said. “Initial research in acupuncture had to follow the model used for studying drugs; we had to have a placebo control group and a treatment group. However, it’s very difficult to create a placebo for acupuncture, though it was tried.” Research used “sham” acupuncture (needles that did not penetrate the skin), or used acupuncture on non-points. Also, all patients in the treatment group had to receive the same treatments, rather than individualizing them, as is usual in acupuncture. Results were confounding.

This study is different. “The patients’ conditions are being compared to before and after treatments, so patients are their own control group,” Wendy explained. “And there is no placebo. It’s an indicator that sources that fund acupuncture research are starting to recognize acupuncture as its own system, which needs its own methodology for testing. They are letting acupuncture function in its own realm. It’s a beautiful project that wouldn’t have been funded 20 years ago.”

The principal investigators are Melissa D. McKee, M.D., a family physician at Montefiore, and Ben Kliger, M.D., a family physician at Beth Israel Hospital. The study is being conducted in collaboration with Albert Einstein College of Medicine of Yeshiva University. Francesca Biryukov, LAc, Dean of the Acupuncture Program at Swedish Institute, persevered in setting up the original internships with Montefiore Medical Center. Her initiative led to acupuncture interns working at a MMC pain clinic and later at a clinic for imuno-compromised patients. The success of students working in these prior clinics paved the way for participation in the current research project.

(1) Participating in the acupuncture study at Montefiore Family Health Center (MFHC) are, from the back row left, intern Katrina Bonoan, supervisor Wendy Whitman, LAc,  MFHC research coordinator Giselle Campos, and in the front from the left are interns Desiree Sale and Jeri Gargano.
(2) Katrina Bonoan checks the action of some acupuncture points while creating a treatment plan.
(3) Acupuncture intern Desiree Sale confers with supervisor Wendy Whitman, LAc.
(4) Jeri Gargano reviews her patient’s chart before providing an acupuncture treatment.