Acupuncture for perimenopausal depression

Being a middle aged woman myself, and experiencing the challenges of the perimenopause, I have plenty of sympathy for everyone going through this phase of our lives!

And I love that there’s a much more open discussion going on about how this powerful transition can affect us. Often the focus is on physical symptoms that we may experience, whether it’s hot flushes or an increased risk of urinary tract infections.

But, I have a particular interest in working with mental health and emotional wellbeing, and the impact on mood for some women at this time should not be underestimated too. Unfortunately, studies have shown that women in perimenopause are at higher risk of depression than premenopausal women.

So, how about acupuncture for perimenopausal depression? Can it help?

Research on acupuncture for perimenopausal depression

Well, I was really pleased to see that 2021 also saw the publication of a systematic review and metanalysis (a study of all the studies) into acupuncture for perimenopausal depression.

The study looked at the results of 25 randomised controlled trials, including 2,200 women.

“Women are twice as likely to suffer from depression in their lifetime as men … Menopausal transition, also called perimenopause, refers to a critical stage of dynamic hormonal flux that occurs at midlife in women … Perimenopause is defined as a “window” of vulnerability for the development of depression.”

“In comparison with standard care, acupuncture alone or combined with standard care was associated with significant improvements in PMD [perimenopausal depression] and reductions of other menopausal symptoms. This finding suggests that acupuncture may be a useful addition to treatment for PMD.”

Extracts from a 2021 systematic review and metanalysis of acupuncture for perimenopausal depression

I’ve written before about how the evidence base for acupuncture is unfortunately not being well integrated into health systems. Hopefully, over time, more and more women who are going through this part of their life and finding it difficult will get access to everything that can help them, including acupuncture.

Ready to try some acupuncture?

Just book online or get in touch. Jessica will be happy to help you.

References

Zhao F-Y, Fu Q-Q, Kennedy GA, Conduit R, Zhang W-J and Zheng Z (2021) Acupuncture as an Independent or Adjuvant Management to Standard Care for Perimenopausal Depression: A Systematic Review and Meta-Analysis. Front. Psychiatry 12:666988. doi: 10.3389/fpsyt.2021.666988

Image by StockSnap from Pixabay

Acupuncture for pain-related depression

If you’re feeling low, or stuck in a bit of a hole, you’re definitely not alone. Unfortunately depression is very common – more than 16% of us can expect to experience it at some point in our lives, making it the fourth leading cause of disability worldwide. And if you’re experiencing chronic pain, unfortunately your risk of depression may be as high as 50%.

Acupuncture for pain-related depression

Chronic pain is a horrible situation to be in, and it can really get you down. We probably all know someone with chronic back pain, who is also suffering with their mood.

I was happy to see though, that a 2021 study concluded, after analysing the results of eight randomised controlled trials, that acupuncture can be helpful for people who are suffering in this way:

“Depression and pain are the most common psychological and physical symptoms in primary care, respectively … Pain has a negative impact on the prognosis and treatment of depression and vice versa. There is a significant correlation between the severity of pain and the degree of depression.”

“… compared with drug treatment, single acupuncture treatment has the same effect in reducing pain and relieving symptoms of depression in patients with CPRD [chronic pain-related depression] … In addition, acupuncture combined with drug therapy has a better effect than a single drug.”

Extracts from a 2021 systematic review and metanalysis of acupuncture for acupuncture for chronic pain-related depression

The researchers also looked at whether any conclusions could be drawn about the safety of acupuncture in this context, and said:

“… single acupuncture treatment has a lower incidence of adverse events compared to oral drugs. Therefore, we can cautiously recommend that acupuncture is a safe treatment for CPRD [chronic pain-related depression].”

Although it’s worth noting, as is so common with acupuncture research, that the study also concluded that more research is needed:

“… due to the insufficient number of included studies, low methodological quality, and heterogeneity of results, further studies using large- and high-quality samples are needed to confirm the role of acupuncture for CPRD.”

Acupuncture for your pain-related depression

So if you’re suffering with pain-related depression and would like to try acupuncture, you can book online or get in touch to get started.

References

Jianyu You, Haiyan Li, Dingyi Xie, Rixin Chen, Mingren Chen, “Acupuncture for Chronic Pain-Related Depression: A Systematic Review and Meta-Analysis”, Pain Research and Management, vol. 2021, Article ID 6617075, 10 pages, 2021. https://doi.org/10.1155/2021/6617075

Image by Peggy und Marco Lachmann-Anke from Pixabay

Acupuncture evidence is underused by other health professionals

Unfortunately, it’s quite frequent that people tell me that another health professional has told them that acupuncture will not be able to help with their problem, when those statements are not supported by the current evidence base.

Of course it would be unfair to expect the average GP to have a deep expertise in acupuncture in the way that an acupuncturist does. And it’s a challenge to keep up to date with all the great research that is being done. Although it’s worth noting that all health professionals do have an ethical obligation to keep themselves up to date on the evidence base for therapies that may help their patients.

So in this context, this article in the British Medical Journal in February 2022 was a breath of fresh air: Evidence on acupuncture therapies is underused in clinical practice and health policy.

What did the research team find?

The article examined the systematic reviews that have been published for acupuncture – a systematic review is a study of the studies. So whereas one particular trial might reach a certain finding and another study a different conclusion, a systematic review seeks to identify all the relevant trials for a particular topic, and look at what conclusions can be reached overall. So what did they find when they did a study of the studies of the studies for acupuncture?

“Despite minor limitations, systematic reviews of acupuncture therapies are generally methodologically rigorous.”

“A recent overview of acupuncture systematic reviews found … acupuncture showed a moderate or large effect with moderate or high certainty evidence in eight diseases or conditions … However, instead of endorsement in health policies and wide use in clinical practice, only a few healthcare systems incorporated acupuncture into clinical practice guidelines.”

“For example, acupuncture is underused in practice for treatment of post-stroke aphasia … by 2015 compelling evidence had accumulated that acupuncture provided important improvement, relative to the best existing therapy … To date, however, only one Chinese clinical practice guideline has recommended acupuncture therapies for treatment of post-stroke aphasia. In the US alone, 10 million patients with post-stroke aphasia could have benefited from acupuncture treatment.”

“Identified research opportunities are underfunded … Promising acupuncture therapies (large effect supported by low certainty evidence) represent potentially fruitful future clinical research targets, and thus require further investigation and research funding support. The overview of systematic reviews found that in 33 outcomes for 22 conditions, acupuncture showed a promising effect. Existing funding and research endeavours in these areas have, however, increased little in the past decade.”

“Take three diseases or conditions in which acupuncture showed promising effects as an example. Depressive disorders, migraine, and opioid use disorders are prevalent and associated with a high disease burden globally … Even though acupuncture therapies have shown large effects supported by low certainty evidence for all three of these prevalent and high burden diseases, they received limited funding for further investigation.”

The authors’ recommendations included using the acupuncture evidence base properly in health system decision making, and a better organised approach to funding acupuncture research.

What’s standing in the way?

A wide range of factors undoubtedly lie behind this, but sticking to just the topic of clinical research, one point to note is that acupuncture research doesn’t have the financial might of big pharma behind it. The profit motive that drives a proportion of medical research is not there for acupuncture treatment. But apart from funding, there are quite a few other interesting issues to consider in creating good quality acupuncture research.

Often a trial will seek to assess acupuncture using ideas that were developed to test drugs, for example using comparisons to an inert placebo. Concepts like ‘sham acupuncture’ are sometimes used, when from a Chinese medical perspective even touching a point (acupressure) is an active therapy. Acupuncture is more akin to a minor procedure than to popping a pill, and not all studies do well in recognising that.

Meanwhile the master practitioners of our medicine, and the practitioners who are well integrated into research institutions and can gain access to research funding, may not always be well aligned. The ‘acupuncture’ used in some studies can feel like a bit of a puzzle.

For example, I was surprised to see a study on acupuncture for pubic symphysis pain (a condition of late pregnancy), which used a number of acupuncture points that are considered unsafe in pregnancy. (Say what now?) Debra Betts, an acupuncturist in New Zealand and probably the foremost expert in obstetric acupuncture globally, wrote an interesting analysis:

“Although no serious complications were reported during treatment it is of concern that the acupuncture points Hegu LI-4, Kunlun BL-60 and Ciliao Bl-32 are listed with no mention of their function in traditional Chinese medicine to induce labour … The study states that these distal points were chosen due to their well known pain relieving effect … This is an interesting study as while it confirms the benefit of offering acupuncture for pelvic pain in pregnancy it also raises questions about the way point prescription acupuncture can be used by physiotherapists and medical acupuncturists.”

Debra Betts, author of The Essential Guide to Acupuncture in Pregnancy and Childbirth

Meanwhile, there are lots of other issues around achieving good quality acupuncture research – meaning both good science, and good Chinese Medicine. The same edition of the British Medical Journal also had a very interesting article about how to improve the quality of acupuncture research.

So, when the benefit of acupuncture has managed to shine through all of these kinds of hurdles, it’s all the more disappointing that the resulting evidence is not always being listened to by medical decision makers.

Conclusions

In summary, it is a great pleasure for me to see the evidence base for acupuncture becoming more complete over time. I am in admiration of all the practitioners and researchers who are dedicating time and energy to building the scientific recognition of our venerable healing art.

Unfortunately it is not an infrequent experience to see acupuncture receiving ill-informed negativity. Sadly this sometimes comes from other medical professionals, despite their relevant ethical obligations.

And so I very much concur with the authors’ recommendations that the evidence base for acupuncture should be used properly in mainstream clinical practice and health policy. As wide a group of people as possible should be able to benefit from the evidence-based benefits of acupuncture.

References

Betts, Debra, Acupuncture Research, https://acupuncture.rhizome.net.nz/acupuncture/research/pelvic-pain/

Elden H, Ladfors l, Fagevik Olsen M, Ostaard H, Hagberg H. Effects of acupuncture and stabilising exercisers as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised singleblind controlled trail.BMJ 2005;330:761

Lu L, Zhang Y, Tang X, Ge S, Wen H, Zeng J et al. Evidence on acupuncture therapies is underused in clinical practice and health policy BMJ 2022; 376 :e067475 doi:10.1136/bmj-2021-067475

Zhang Y, Jing X, Guyatt G. Improving acupuncture research: progress, guidance, and future directions BMJ 2022; 376 :o487 doi:10.1136/bmj.o487

Acupuncture for shingles: what does the evidence say?

Shingles is a horrible business! So I was really pleased to see that some evidence is starting to build up around acupuncture for shingles.

Shingles

Shingles is an infection of the herpes zoster virus, the same one that causes chicken pox, but in this case it’s in the nerves, which is why its notorious as such a painful condition. Often it follows the path of a nerve around one side of your torso, which is bad enough, but it can also happen on the face or other very uncomfortable parts of the body.

If you had chicken pox as a child, shingles can flare up in adulthood if your immune system dips due to ageing or going through a very stressful or draining time in your life. The virus has been dormant in your system all that time, and finally manages to get the upper hand over your immune system.

Pain, itching and a weeping rash are common symptoms.

Postherpetic neuralgia

Postherpetic neuralgia (PHN) can be an unfortunate complication of shingles, with a burning pain that can continue long after your shingles rash itself has cleared.

Risk factors for postherpetic neuralgia include being over 50, having severe shingles or shingles on the face or torso, having other existing conditions such as diabetes, or not receiving prompt treatment for your shingles.

How much research has been done on acupuncture for shingles?

Individual studies can produce conflicing answers, so it’s great if the research has advanced to the stage where scientists have done the kind of studies that are called systematic reviews or meta analyses. These are studies of studies, investigating all of the studies that have been done on this topic, and trying to draw an overall conclusion.

Often we’ll find that acupuncture research is not yet at the stage where this level of research has been done yet, so in this case I was happy to see a number of recent meta analysis studies about acupuncture for shingles and/or acupuncture for postherpetic neuralgia.

What does the research say about acupuncture for shingles (or herpes zoster, HZ)?

Overall, the researchers concluded that more research is still needed, but based on what is available so far, they did have some positive things to say:

Acupuncture may be effective for patients with HZ. Nevertheless, this finding should be validated by conducting high-quality trials with a larger sample size.

Conclusion of a meta analysis in 2021, after analysing the results of 21 randomised controlled trials

And what about acupuncture for postherpetic neuralgia (PHN)?

Acupuncture may reduce pain intensity, relieve anxiety and improve quality of life in patients with PHN. Further randomized trials with larger sample sizes and of higher methodological quality are needed to confirm these results.

Conclusion of a meta analysis in 2018

There was not enough evidence to suggest that acupuncture was superior to pharmacologic therapy in improving global impression or life quality. No adverse effects about acupuncture were reported. In all, acupuncture is safe and might be effective in pain relieving for patients with PHN. Given the low quality of included studies, the results are not conclusive and more large-scale RCTs with high quality are needed.

Conclusion of a meta analysis in 2019

Book in for some acupuncture

If you’re suffering with the horrors of shingles, you have my sympathy! If you’d like to book in for some acupuncture, get in touch, or click here to book:

References

2018 study: Wang Y, Li W, Peng W, Zhou J, Liu Z. Acupuncture for postherpetic neuralgia: Systematic review and meta-analysis. Medicine (Baltimore). 2018;97(34):e11986. doi:10.1097/MD.0000000000011986

2019 study: Pei W, Zeng J, Lu L, Lin G, Ruan J. Is acupuncture an effective postherpetic neuralgia treatment? A systematic review and meta-analysis. J Pain Res. 2019;12:2155-2165
https://doi.org/10.2147/JPR.S199950

2021 study: Cui Y, Wang F, Li H, Zhang X, Zhao X, Wang D. Efficacy of Acupuncture for Herpes Zoster: A Systematic Review and Meta-Analysis. Complement Med Res. 2021;28(5):463-472. English. doi: 10.1159/000515138. Epub 2021 Apr 6. PMID: 33823512.

Image by Martin Büdenbender from Pixabay

Acupuncture in Moora

Small towns deserve all the same services as big cities! Especially when it comes to our health. The positive evidence base for acupuncture is slowly growing, confirming the benefits for a range of conditions as diverse as hayfever and migraines.

And even Australia’s country doctors are on board – in 2013 a study in regional and rural NSW showed 68% of GPs referring patients for acupuncture at least a few times per year. 

So the good news is that more acupuncture is coming to Moora! From 12 November, I’ll be offering appointments twice a month at the Moora Wellness Centre on Gardiner Street.

Acupuncture for everyone

If you’d like to book in to see how acupuncture may be able to help you, you’ll be in good company.

A a 2005 research project showed that nearly 1 in 10 Australians had used acupuncture within the last year. The study showed more people seeing acupuncturists in NSW, Victoria and Queensland than in our other states, so I’d guess that’s because that’s where it’s been most available.

And acupuncture is on the move across the world, with global acupuncture demand estimated to be climbing at 14.5% per year, as more and more people find out about its benefits.

Joining the Moora Wellness team

“We’re so pleased Jessica’s going to be joining us here at the Moora Wellness Centre!  Moora has a way of drawing people in, and we’re so thrilled Jessica is bringing her wealth of knowledge to practice here. Whether you live in a city or rurally, everyone deserves access to the full range of health services available.”

Joley Holliday, Moora Wellness Centre

Loving the country life

I’ve lived in big cities and tiny villages, and there’s a huge soft spot in my heart for both. When I moved from the UK to Perth, I wasn’t planning to be one of those Perth folk who never leave the metro area, except to fly to Bali! I’ve been out and about in WA, enjoying all the natural beauty this gorgeous state has to offer.

It was passing through Moora on the way back from a camping trip, that inspiration struck. I found myself gazing at the Moora Wellness Centre, and thinking, huh! Then I drove back to Perth, and the natural beauty on the way just blew me away. How can I fit more of this into my life, I was thinking? So I dropped an email to Joley and Marcus…

Back story

What brought me to this point? I studied acupuncture in the UK and qualified in 2005, and built up a busy practice in London. In the end though I couldn’t resist the before the lure of WA’s natural beauty and sunny skies.

I practice two styles of acupuncture in an integrated way – Traditional Chinese Medicine (TCM) and Five Element style. These both date back through 2,000 extraordinary years of the history of traditional east Asian medicine. Five Element acupuncture is taught at colleges in the US and Europe, but the full training is not available in Australia, so usually it’s harder to access here.  It has a particular focus on mental and emotional wellbeing.

I’m AHPRA registered and recognised by the health funds.

Book your treatment

If you’re ready to give acupuncture a try, and keen to support a new local service, get in touch, or book online:


References

Wardle, Jonathan & Sibbritt, David & Adams, Jon. (2013). Acupuncture Referrals in Rural Primary Healthcare: A Survey of General Practitioners in Rural and Regional New South Wales, Australia. Acupuncture in medicine : journal of the British Medical Acupuncture Society. 31. 10.1136/acupmed-2013-010393.

Xue, Charlie & Zhang, Tony & Yang, Angela & Zhang, Claire Shuiqing & Story, David. (2009). Recent developments of acupuncture in Australia and the way forward. Chinese Medicine. 4. 10.1186/1749-8546-4-7.

https://www.marketwatch.com/press-release/acupuncture-market-industry-trends-size-growth-insight-share-competitive-analysis-statistics-regional-and-global-industry-forecast-to-2023-2020-08-18#: (para 6)

Five Element Acupuncture in Perth

Here I am with a few words about the joys of Five Element acupuncture, from Marie Hopkinson’s fantastic Chinese Medicine Podcast.

Five ElemeFive Element acupuncture interviewnt acupuncture interview

A few quotes…

I think I might be the first person practising Five Element acupuncture in Perth … the thing that’s really special about Five Element is that it really looks at you, the patient, as an individual, in a lot of depth … this is a strength of Chinese Medicine in general … and Five Element takes it to an even deeper level.

Chinese Medicine has this really integrated understanding of how the mind and the body move together … people often have no idea of the things that acupuncture CAN help with … people often don’t think to mention some of the ways they’re not feeling great, unless you ask the questions … people tend to be drawn to the practitioner who is really well suited to what they need.

One thing I really quickly realised, when I was studying acupuncture, and I had my first few patients, is, nobody is dull. Everybody is fascinating. It’s like you sit with someone, and have a conversation with them for like a half hour, and it’s like this beautiful little journey of discovery. And it’s not uncommon that for them it’s a journey of self discovery. Hearing questions, thinking about themselves, feeling really deeply heard, in a way that isn’t commonplace.

So holding that space, really seeing someone, really hearing them, and doing the background thing of ‘what is it that that person needs?’, is a total joy to participate in.