The Acupuncture Randomised Trial (Art) for Tension-Type Headache - Details of the Treatment

Abstract

Objective The goal of this paper is to describe the characteristics of physicians and their interventions in a large, multicentre randomised trial of acupuncture for tension-type headache known as ARTTTH, in order to enable acupuncturists to assess the study interventions. Methods Participating physicians were recruited whose qualifications met or surpassed those of physicians currently accredited for providing acupuncture by state health funding agencies in Germany. Semi-standardised treatment strategies for acupuncture and minimal acupuncture were developed in a consensus process with acupuncture experts. Atotal of 270 patients suffering from episodic or chronic tension-type headache were randomised to 12 sessions of semi-standardised acupuncture (three predefined 'basic' points, recommendations for additional points given, but individual choice of additional points possible), standardised minimal acupuncture (superficial needling of at least 5 of 10 predefined, bilateral, distant non-acupuncture points) or a waiting list. Forty two physicians, trained and experienced in acupuncture, from 28 centres in Germany participated in the trial. Results The median duration of acupuncture training of trial physicians was 500 hours (range 140 to 1350 hours). Physicians had 10 (<1 to 25) years acupuncture experience. The three 'basic' points (GB20, GB21 and LR3) were treated in 96%, 82% and 97% of sessions, respectively. Frequently treated optional points included LI4 (67%), SP6 (50%) and ST36 (46%). Ten of the 42 physicians stated that they would have treated patients differently outside the trial. The trial found a significant effect of acupuncture over waiting list but not over minimal acupuncture. Conclusions In general, trial physicians complied well with the predefined interventions. Arelevant minority of participating trial physicians stated that they would have treated patients differently outside the trial.

Acupuncture for the prevention of tension-type headache

“…This update includes 12 trials described in 22 publications (including published protocols and papers reporting additional aspects such as treatment details or cost-effectiveness analyses) (Ahonen 1984; Carlsson 1990; Endres 2007; Jena 2008; Karst 2001; Kwak 2007 Melchart 2005; Söderberg 2006; Tavola 1992; White 1996; White 2000; Wylie 1997). …”

“…For three trials included in the individual patient database of the Acupuncture Trialists Collaboration (ATC), an international collaborative network for high quality randomised trials of acupuncture for chronic pain (see Vickers 2010; Vickers 2012 and https://www.mskcc.org/cancer-care/treatments/symptom-management/integrative-medicine/acupuncture-trialists-collaboration), we obtained uniformly re-analysed summary data for number of headache days and the number of responders for calculation of effect sizes (Jena 2008; Melchart 2005; Vickers 2004). We use these data a) to make our findings as comparable to the results of the ATC as possible and b) to make sure that a comparable high quality analysis method was used.…”

A Randomized Controlled Trial of Tai Chi for Tension Headaches

“…As early as 1990, relaxation therapy and biofeedback had been shown to be effective in the treatment of TTH (18), and Tai Chi may have an effect similar to both of these interventions. Also, it has been demonstrated that acupuncture is effective in the treatment of TTH (19,20), and it is believed in TCM theory that acupuncture and Tai Chi operate along the same principles (21). …”

The Status and Future of Acupuncture Clinical Research

“…The main results of these trials have been published in major journals [1][2][3][4] ; details of the protocols and the treatments actually provided were published in complementary and alternative medicine (CAM) research journals. [5][6][7][8][9][10] Participating physicians had to have at least 140 hours of acupuncture training. About 70% had 350 hours of training or more.…”