Effect of Acupuncture on Smoking Cessation and Chronic Neck and Shoulder Pain
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AbstractTobacco smoking, and chronic neck and shoulder pain are major public health problems in the modern society, and both lack effective treatments. This thesis presents two trials focusing on acupuncture as a treatment for these two problems.
Study A was undertaken to examine the effects of acupuncture on smoking reduction and cessation, and to examine whether some ‘real’ acupoints are more effective than ‘sham’ acupoints for smoking cessation. An additional aim was to examine whether acupuncture treatment can have a long-term effect on smoking withdrawal.
Study B was undertaken to examine whether acupuncture might have a positive influence on chronic pain in the neck and shoulders. Since there might be many ‘psychological’ problems accompanying chronic pain, the thesis also examined to what extent acupuncture might improve some of these problems, such as headache, quality of sleep, and depression. An additional aim was to investigate whether possible positive effects of acupuncture are long-lasting.
In Study A, 46 healthy men and women (39±9 years old, mean±SD), who smoked 20±6 cigarettes daily volunteered to participate. The subjects were randomly assigned to a test group (TG) or a control group (CG). Acupuncture was applied at six sessions during three weeks either at anti-smoking acupoints (TG) or at acupoints assumed to have no effect for smoking cessation (CG). Blood samples for measuring variables related to smoking, i.e. serum cotinine and serum thiocyanate, were taken before the first, after the last one and 8 months after the last treatments. Each subject filled in questionnaires about their smoking habits and attitudes at the same occasions, and again 5 years after the last acupuncture treatment.
In Study B, 24 female office workers (47±9 years old, mean±SD), who had neck and shoulder pains for 12±9 years, were randomly assigned to a test group (TG) or a control group (CG). Acupuncture treatment was applied ten times during 3–4 weeks either at presumed anti-pain acupoints (TG) or at placebo acupoints (CG). A physician measured the pressure pain threshold (PPT) in the neck and shoulder region with algometry before the first treatment, just after the last one, and 6 months after the treatments. Questionnaires on muscle pain, headache and on changes in social and psychological variables were completed at the same occasions and again 3 years after the last acupuncture treatment.
In Study A, altogether 31% of subjects in TG had quit smoking completely at the end of the treatment, against none in CG. The subjects’ reported cigarette consumption fell on average by 14 (TG) and 7 cigarettes (CG) daily during the treatment period. For both groups the values rose on average by 5–7 cigarettes smoke per day at 8 months follow-up, and there was no systematic change thereafter. Consequently, TG showed a maintained reduction in smoking; no lasting effect was seen for CG. The TG reported that the taste of tobacco was worse than before the treatments, and also the desire to smoke fell. For TG the serum cotinine concentration decreased, and the values correlated with the reported cigarette consumption.
In Study B, the subjects’ reported intensity and frequency of pain, and the degree of headache fell more for TG than for CG during the treatments. At 3 years follow up TG still reported less pain than before the acupuncture treatments, contrary to what CG did. For TG the value of PPT of some muscles increased during the treatments and remained higher 6 months after the treatments, which contrasts the situation for CG. The pain-related activity impairment at work was significantly less in the TG than the CG by the end of treatment and 3 years later. The TG showed further improvements in most pain-related variables, i.e. quality of sleep, anxiety, depression and satisfaction with life right after the treatments, at 6 months and 3 years follow-ups, and was again significantly different from the CG.
Appropriate acupuncture may help motivated smokers to reduce their smoking, or even quit smoking completely, and the effect may last for at least 5 years. Different acupoints appear to have different effects for smoking withdrawal. Acupuncture may affect the subjects’ smoking by reducing their taste of tobacco and their desire to smoke.
Appropriate acupuncture may reduce chronic pain in the neck and shoulders and related headache, and may also improve the activity at work and several relevant social and psychological variables in people with chronic pain. The effect may last for at least three years. Hypothetically, acupuncture may reduce chronic pain by breaking the vicious circles involved e.g. pain, depression and reduced activities.
LIST OF PAPERS
1. He D, Berg JE, Høstmark AT. Effect of acupuncture on smoking cessation or reduction for motivated smokers. Prev Med 1997;26:208-214. Abstract.
2. He D, Medbø JI, Høstmark AT. Effect of acupuncture on smoking cessation or reduction: An 8-month and 5-year follow-up study. Prev Med 2001;33:364-372. Abstract.
3. He D, Veiersted KB, Høstmark AT, Medbø JI. Effect of acupuncture treatment on chronic neck and shoulder pain in sedentary female workers: a 6-month and 3-year follow-up study. Pain 2004;109:299-307. Abstract.
4. He D, Høstmark AT, Veiersted KB, Medbø JI. Effect of intensive acupunctur on pain-related social and psychological variables for women with chronic neck and shoulder pain– an RCT with six month and three year follow-up. Acupunct Med 2005;23(2): 52-61. Abstract.