January 2007

 

CATARACT/ IOL

 

Acupuncture tested to reduce anxiety levels in cataract patients


by Matt Young EyeWorld Contributing Editor

 

 

Study finds acupuncture decreased anxiety

Many people may question the efficacy of acupuncture, but fewer ophthalmologists should. The ancient Chinese medicinal technique was recently analyzed by Luigi Gioia M.D., Luca Cabrini, M.D., Ospedale San Raffaele, Milano, Italy, and colleagues, who were curious to find out whether it could help relax patients undergoing cataract surgery. “In our study, acupuncture reduced anxiety significantly during and at the end of cataract surgery,” Dr. Cabrini reported in the study, published in the November 2006 issue of the Journal of Cataract & Refractive Surgery. “Pre-operative relaxation cannot explain the results.”

Typically, patient comfort during cataract surgery is achieved using sedative and analgesic drugs. While acupuncture as a part of cataract surgery would certainly be a non-traditional application of this ancient Chinese medicinal technique, the study suggests if popularized, it might have some relaxation benefit.

An uncommon procedure

Seventy-five adults with an American Society of Anesthesiology score I to III participated in the study. On their surgery day, patients were asked to rate their baseline anxiety on a visual analogue scale (VAS), with 0 being no anxiety and 100 being unbearable anxiety. Patients’ average arterial pressure, heart rate, and pulse oximetry were also recorded. Topical anesthesia (lidocaine 4%) was applied to all patients.

Patients were assigned to one of three groups: group A (patients left alone in a quiet room for 20 minutes), group B (patients that received true acupuncture), and group C (patients that received sham acupuncture). For those unfamiliar with acupuncture, the treatment points selected may seem strange, but Mark Packer, M.D., Eugene, Ore., has heard of at least one: Auricle Shenmen.

“It’s known for its calmative effects,” said Dr. Packer, who has studied acupuncture extensively and received treatments himself. The other points included LI-4 (long intestine 4 [Hegu], on the dorsum of the hand); PC-6 (pericardium 6 [Neiguan], on the volar aspect of the forearm); H-7 (heart 7 [Shenmen]), on the volar aspect of the wrist); TE-5 (triple energizer 5 [Waiguan], on the dorsal aspect of the forearm); and LV-3 (liver 3 [Taichong]), on the dorsum of the foot).

Surprising results

As for the results, the baseline anxiety score was 46 +/–24 for group A, 52 +/–20 for group B, and 39 +/–19 for group C. But by the pre-op period, the score increased significantly to 50 ± 5 in Group A, decreased significantly to 22 ± 3 in group B, and virtually stayed the same at 36 ± 4 in group C.

By the post-op period, group A’s anxiety level decreased again to around baseline levels (at 39 ± 5). Group B’s anxiety level at 19±3 and group C’s at 31 ± 4 stayed virtually the same.

Meanwhile, pre-op mean arterial pressure was statistically higher than baseline in the three groups, but the differences were clinically negligible. Intra-op mean arterial pressure trends were similar in all three groups. The study did not assess pain and sedation.

A practicable measure?

Dr. Cabrini found that acupuncture caused no adverse events and did not prolong the duration of surgery.

“It did not require additional monitoring or dedicated personnel,” Dr. Cabrini reported. “Given the positive effect we observed, we think an acupuncture approach is worthy of study in different medical and surgical settings characterized by procedural anxiety in awake patients. Physicians can acquire sufficient knowledge in acupuncture, allowing them to administer it, which is particularly valuable in settings in which anesthesiologists only work on call.”

The researchers chose acupoints considered in traditional Chinese medicine to be sedative and analgesic (as well as ones distant from the ophthalmic operative field). But, Dr. Cabrini said other acupoints could conceivably be chosen and produce similar results. Points on the back were not used for convenience reasons. Dr. Packer said he isn’t surprised acupuncture had the ability to reduce anxiety for these patients. “Acupuncture works a lot like massage except it’s a bit more precise and doesn’t require as much labor on the part of the therapist,” said Dr. Packer. “There’s not a lot of kneading and pushing muscles around. You just slide little needles in to get nerve stimulation.”

Nonetheless, Dr. Packer said although the therapy has been found in some studies to reduce heart and respiration rates, acupuncture is still fairly elusive to scientific study. “It’s sort of a soft area,” Dr. Packer said. “It’s not like measuring IOP. Part of the theory of acupuncture is that it has to be individualized. You often use a different set of points for one person versus another person even though perhaps the goal is the same to reduce anxiety.”

As for Dr. Packer’s clinic today, he said it doesn’t employ acupuncture yet, “but it’s a possible thing in the future.”

Editors’ note: Dr. Cabrini reported no financial interests related to the study. Dr. Packer has no financial interests related to his comments.

Contact Information

Cabrini: cabrini.luca@hsr.it

Packer: 541-687-2110, mpacker@finemd.com

Acupuncture tested to reduce anxiety levels in cataract patients Acupuncture tested to reduce anxiety levels in cataract patients
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