Acupuncture as a nonconventional treatment for chronic neck pain
Acupuncture as a nonconventional treatment for chronic neck pain
IntroductionNeck pain has been classified as one of the commonest problems among the people. This condition arises from various disorders or it may originate from tissues located at the neck (Hush, et al., (2009).The neck is also known as a cervical spine. The necks structure is characterized by vertebrae which run from the upper torso to the skull’s base. The stability of the spine is associated to ligaments and muscles that run along the vertebrae (National Institutes of Health. (2013). A neck’s main importance is its mobility and the support it accords to the head. It is prone to injuries because it is not offered much protection like the rest of the spine. Injuries normally cause less and restricted mobility and triggers NAIP. Unfortunately neck pain are not accorded seriousness, most people treat the neck pain as temporary. There are unique cases where the symptoms do not go away and hence diagnosis and corresponding treatment is required (American Academy of Orthopaedic Surgeons (2013).
Researchers (De Loose, V., Burnotte, F., Cagnie, B., Stevens, V., & Van Tiggelen, D. (2008). have found out that the pains are caused by several factors such as wear and tear, sprains and abnormalities of the neck tissue. There is evidence of neck pains arising from other pains such as arm or shoulder pains (De loose, 2008). Normally activities such as extreme bends of the neck, falls and vehicle accidents can cause neck injuries. In certain situations damage of the neck can damage the spine causing paralysis. Researchers have also found out that Spondylosis which occurs in people above the age of 40, adds strains to neck joints creating a path for chronic neck pain. But the condition is treatable through both conventional and nonconventional methods.
Researchers and doctors have identified acupuncture as a nonconventional treatment method which is a very effective method for treating chronic neck pains. Researcher (Blosssfeldt, 2004), says that, acupuncture is gaining momentum as a popular nonconventional treatment method for chronic neck pain. He also adds that, the method has been well tolerated and has low risk of adverse effects. (Liang et al, 2008) says that, a combination of both traditional and modern acupuncture technique usually result in a documented and improved neck pain patterns. (Blossfeldt, 2004) adds that acupuncture is widely accepted and it is utilized as a complementary therapy useful in neck pain management originating from cervical spondylitis.
Researchers have carried out studies relating to acupuncture systematic review with an aim to find out on acupuncture effectiveness. The studies have found effectiveness evidence as inconclusive (salter et al, 2004). There are studies which have produced results which are positively favoring acupuncture and there are other results which have produced negative findings on the effective of the method (salter et al, 2004).
Due to the varying results, this research was developed to find out on the effectiveness of acupuncture method as a non-conventional method in treatment of chronic neck pains in relation to other research findings. In respect to national health statistics and reports, Survey data analysis can be used by medical professionals to measure the pain levels of patients before and after acupuncture treatment. Gathering results from various studies and comparing with the structures of acupuncture and preventive measures of neck pains can help us determine on the effectiveness of acupuncture as a treatment method. In this literature review the researcher will review on 1) how to establish the viability of acupuncture therapies in the treatment of chronic neck pain; 2) understanding of how sham, shallow and randomized acupuncture therapies are utilized in the treatment of chronic neck pain; 3)provide a conclusive evidence of the success of acupuncture as an ideal method of relieving pain; 4)establish the effects of the three acupuncture therapies in the treatment of individuals with chronic pain of the neck; 5)offer recommendation of the viability of acupuncture as a treatment option that can be used by people with chronic neck pains. The researcher will also compare the duration of acupuncture treatment with other methods and also the cost associated and risk factors thereof.
METHODOLOGYTarget PopulationThe research data collected in this study focused on patients suffering from chronic neck pain. The individuals used in the research fell within the age of 21 and 55 years old. Although there are many patients who report about neck pain ailments in different health care facilities across the United States, patients withinthe ages of 21 and 55 years old were ideal for this research study. This was due to the fact that they were easier to track their progress of healing over a longer period of time. Elderly patients over the age of 55 years were not best placed in this research considering the various attributes in the healing processes of such people, which was proven to be relatively lower. Most of the data aboutindividuals with chronic pain of the neck was randomly collected in health care facilities in the State of California, United States. The majority of these patients were diagnosed with chronic neck pain and were put under a special focus while three acupuncture methods of therapies were performed(Witt 2004, p. 99). The study generally involved a thorough investigation of 191 patients in California’s health care. It is important to acknowledge that the various patients were deliberately initiated to acupuncture treatment as their decision to try the alternative medical practice after unsuccessful treatments in the mainstream medical procedures.
There were certainly no limitation on the sex of the patients; hence the research involved both male and female patients. Additionally, there was no specified number of male or females in the study, as patients, treatment and progress of treatment of patients was randomly taken. Further, it was assumed that both male and female patients presented similar responses to the different acupuncture therapies performed in the study(Sun et al, 2009, p. 850).The research was not limited by either ethnicity or race, although believed to have different characteristics in regard to various medical procedures.
Variables of the studyThe dependent variables in this study included the neck pain as an ailment caused by various aspects such as physical injury and disease or condition among others. The rates of cases involving chronic neck pains during the period of this study were generally unprecedented as the causes of such ailments greatly varied. Chronic neck pain among the patients varied in regard to the specific causes, which in this case included degenerative disc disease, neck injury, neck strain, herniated disc as well as pinched neck(Sun et al, 2009, p. 850). The first step in the treatment procedure involved a thorough diagnosis of common neck infections that caused the chronic pain. The research exploits treatment of such neck pains using acupuncture which falls into three categories including optimized acupuncture, shallow acupuncture and sham acupuncture.
Research LimitationsThe key limitations were based on neck pain due to common infection like virus infection of the neck and lymph nope swelling, as well as other infections such as tuberculosis of the neck, meningitis, and infection of spine bones around the neck. It was difficult in the study since some of patients did not present themselves on the day of the study. The study also used a large number of patients which was a challenge for the researcher. The different patients involved in this study had chronic neck pains attributed to extremely different causes, which included physical injuries, some rare infections, and virus infections among others(Witt 2004, p. 99). The patients with this problem are generally taken through the three acupuncture therapies, regardless of the cause of their condition(Hush 2004, p. 1533). The fact that all patients are uniformly taken into similar medical procedures without being categorized in relation to their specific cause of chronic neck pain remain as the greatest limiting attribute of this research. Additionally, time was a limiting factor since the time allowed for the research was not enough to efficiently tackle critically the objectives of the study.
Research criteria and Database usedIn this study, the items were collected through searching peer reviewed journal articles and therefore, the researcher thoroughly searched in various databases for article that provided information for patients suffering from chronic neck pains, specifically those individuals between the age of 21 and 55 years old. The researcher further categorized the data collected to form two groups of patients of the age bracket of 21 and 34 years and those between 35 and 55 years old. The creation of these two groups was essential as taking a wider range of people of ages 21 to 55 years old would present relatively a higher deviation in the healing processes of the patients, as those above the age of 35 years present a much longer period of healing as compared to the youthful 21 to 34 years group. The researcher focused the search on SPORT Discus, Academic Search Premier, BMJ Research Articles and Gov., database.
Keywords used in the studyThe key terms the researcher commonly used while searching for the relevant articles included: Chronic neck pain, cervical pain types of acupuncture, alternative medicine, Sham acupuncture, Shallow acupuncture and Randomized acupuncture.
OVERVIEW OF ACUPUNCTURE PRACTICEPracticing acupuncture started many centuries ago as a type of medication in China. It is the practice of implanting needles at certain points of the human skin as a form of therapy. In acupuncture practices, there is no involvement of drugs but only the needles are enough to accomplish the therapy (Liang et al, 8). The practice originated from China and has been noted to spread all over west of Europe (Liang et al, 8).As argued by the model on Chinese medicine, the specific places that the acupuncture needles are placed lies on the path named meridians where the dynamic energy goes through, hence allowing its access to control and regulate the flow of energy which is believed to be the cause of force imbalance (Willich et al, 2006, p. 98).
Populations and AcupunctureAcupuncture has been practiced in several parts globally, especially in Europe even though it is in its inception stages in the United States. According to NHI survey done in the year 2007 that also considered the use of CAM in America,where 1.4% of the respondents were found to be using acupuncture before then. The 3.1 million of the American population claimed they only practice it majorly for severe migraine and repetitive pain. The study showed that half of the respondents used acupuncture to treat chronic neck pain (Sun et al, 2009, p. 850).
The practice should obviously be regarded by physicians as an ideal treatment preference due to the backing it has received from those individuals who have used it in the treatment of chronic neck pain. Subsequently, the study did not restrict the adults basing on their gender due to limited research.
CHRONIC NECK PAINChronic neck pain is an ailment that is characterized by pain in the neck that lasts for an unusually long period of time, commonly over a period of three months(Blossfeldt, 2004). Although different from the common medical conditions of neck pains that last for only days, chronic neck pain is typically an ailment that takes even years without success in its treatment in the mainstream medical practices(Irnich, 2002). Chronic neck pain is usually associated with a number of disorders, as well as diseases that can involve any of the tissues around the neck(Witt 2004, p. 99). For instance, the common causes of this condition are strains of the neck, injury of the neck like a herniated disc, pinched disc, or whiplash, and degenerative disc disease. In addition, chronic neck pain is also linked to common infection like virus infection of the neck and lymph nope swelling, as well as other infections such as tuberculosis of the neck, meningitis, and infection of spine bones around the neck. Some patients also had chronic neck pains caused by extremely different causes, which include physical injuries, some rare infections, and virus infections among others. Further, chronic neck pain is also caused by certain infections like virus infection of the neck and lymph nope swelling, as well as other infections such as tuberculosis of the neck, meningitis, and infection of spine bones around the neck.
RISK FACTORS OF CHRONIC NECK PAINSChronic neck pain is generally caused by numerous factors ranging from physical injury to certain infections around the neck body tissues. Since neck pain affects the muscles around the body areas of the neck, it becomes painful to move the neck (De Loose, 2008, p. 475). In order to avoid or to prevent neck pains for the patients, it is always essential to consider staying away from activities may twist the neck and subsequently aggravate the already painful section of the neck(Witt 2004, p. 99). Therisk factors for the pain usually include injury from involvement in activities like motor vehicle accidents, horse riding, contact sports and bull riding among others, degeneration of cervical disc also known as Spondylitis, neck bent and twisting positions (De Loose, 2008, p. 475).In addition, it is also advisable to have activities that will enhance neck strengthening exercise, as well as neck bracing, reduce TV watching usage of safety belts in motor vehicles and going to the gym for exercise.
TYPES OF ACUPUNCTURE USED IN CHRONIC NECK PAIN TREATMENTOptimized acupuncture therapyThe practice of optimized acupuncture therapy involves the utilization of traditional acupuncture, which is usually followed by intradermal needle therapy, commonly referred to as INT(Hush 2004, p. 1533). The use of OAT usually consists of the use of nine acupuncture points typically selected for an optimized acupuncture therapy group on the advice and consensus of the national expert committee of the OAT procedures. In this case, four points are subsequently located by physician intending to perform the OAT. The points selected are usually the cervical positive reactions planes found in the top and bottom of the cervical planes as well as horizontally away from the corresponding cervical vertebra(Witt 2004, p. 99). The study found that this type of acupuncture practice is highly sensitive and hence the need to be performed by an individual with more than five of practice experiences
Sham acupuncture therapyThe practice is put into use only as a tool for control in the scientific research in order to measure the efficiency of real acupuncture in various disease treatment. This type of acupuncture involves the use of skin penetrating shallow needles on the specified sham groups’ tender points.The tender points that are used in this method of acupuncture therapy are categorized as the key areas recommended for the acupuncture, which are the Ah Shee, also referred to as “oh yes point”. The points are crucial in this therapy and have to be used throughout the treatment procedure. Typically, the location of sham points is commonly defined by 25mm lateral extending to the standard location used for the OAT group.They include: the sham point of Dazhui (GV14) 25mm, which is 25 mm vertically below the usual standard GV14, sham points of (S115) Jianzhongshu and Huatuojiaji, which is 25 mm lateral to standard S115 (Liang et al, 8). After the sham acupuncture, individuals undergoing the process or patients are treated through the use of point pressing (De Loose, 2008, p. 475). The findings show that a patient does not notice whether it is sham or real acupuncture being used. The results showed that the variation between real and sham practices are caused by habituation or the control effects. If the real acupuncture is efficient compared to the sham, then the habituation and control effects such as expectations of the patient, behavior and beliefs are present.
Shallow acupuncture therapyShallow acupuncture group undergoes similar procedures as the other OAT groups.However, the physicians are required to insert the needles in a vertical manner in order to reach the subcutaneous level at a specified depth of not more than 3 mm (Salter et al, 2004). Needle manipulation or any other sensation is prohibited in this particular group. Ultimately, after the shallow acupuncture, the patients are additionally treated by INT through the use of a similar method as in the other OAT groups. It was found that the therapy do not fully treat the pain fully due to its shallow penetration hence the need for additional treatment that follow the same procedures. It results to a more efficient treatment in comparison to other therapies though takes much time (Salter et al, 2004).
ACUPUNCTURE AS AN IDEAL METHOD COMPARED TO PHYSIOTHERAPYZhuang (2012); Robertshawe, (2008), compares the use of acupuncture and physiotherapy in the treatment of chronic neck pain in a research that took place in China. The research involved screening of a total of 310 patients. The patients were then randomly split into two equal groups, where one group was treated using acupuncture method, while the other group received treatment through physiotherapy. The outcome of the treatment of the two procedures revealed that patients treated under acupuncture procedures had better results in relieving neck pain, particularly after a period of three months. It is essential to acknowledge that physiotherapy is an alternative medical practice that can be used in the treatment of chronic neck pain. While acupuncture therapies generally used sterilizes needles that are usually inserted in the area around the neck depending on the type of acupuncture used, physiotherapy does not involve the use of needles. Physiotherapy utilizes several types of manipulation as well as exercise to relieve pain. The common illustration of the use of physiotherapy is the stretch, strengthen and straighten up exercise movements of the neck (Robertshawe, 2008; Willich, 2006).
EFFECTS OF ACUPUNCTURE TREATMENTWhite, (2001); Ji-Eun, (2010), researched about the adverse effects following a use of acupuncture to treat patients with chronic neck pain. In his survey, which included a prospective survey of 32,000 consultations with physiotherapists and doctors, the researcher, Adrian White aimed at ascertaining the incidence of adverse effects that are related to acupuncture treatment, as practiced by British doctors during that time. The research utilized data that were collected for the June of 1998 to February of 2000, from a total of 78 acupuncturists. Altogether the resulting significant effects were 43, subsequently giving only a rate of only 14 patients of the 10,000 patients included in the data. The results of this study showed that only 0.14 percent of the patients who used acupuncture in the treatment of chronic pain experience adverse effects (White, 2001). All the adverse effects were reported to have had cleared within the period of one week after the therapy. Similar diminishing effects were characterized at a longer period, except for only one incident that lasted for several weeks. The result derived from the data of acupuncture treatment did not report any serious adverse effects. The rates can only be classified as minimal considering that it was only 14 adverse effects out of the total 10,000 patients who were analyzed with the data provided (White, 2001; Ji-Eun, 2010). Generally, these effect rates do not give significant risk per individual patient.
RECOMMENDATION ON ACUPUNCTURE’S VIABILITYThe article by Chen, et al., (2010), offers exclusive views on acupuncture given by various physicians. The research by Chen among other authors who contributed to the article, there study targets collecting information that addresses the role of acupuncture in the management of pain in regard to opinions of physicians who manage such conditions. The research was conducted between 2007 and 2008 using a nationwide e-mail to 1083 physicians who were in active acupuncture practice in the United States. Chan et al., (2010) found that the overwhelmingly majority of the responders of the survey had a positive attitude and favorable experience of the use of acupuncture as an alternative modality in the management of chronic pain. The results of the survey subsequently indicate that acupuncture is considered effective by physicians in the management of chronic neck pain.
CASE STUDIES:Acupuncture for patients with chronic neck painWitt et al., (2006) undertook the study in examining how effective acupuncture as an alternative treatment for neck pain treatment in comparison to patients who used routine medical care. The study used a random approach of more than 14000 individuals aged above 18 suffering from neck pain symptoms within a period of 6 months. Also took a non-acupuncture for 15 sessions within a period of 3 months. The acupuncture category were given injections without any other acupuncture treatment. The group which was controlled was not treated using acupuncture but both groups could use any other mode of treatment. The study found out that patients using routine care and add on acupuncture treatment showed significant improvements in both pain and quality of their lives in comparison to patients who only used routine treatments. Therefore, the results concludes that acupuncture can be used alongside routine treatments to achieve optimal results.
Efficacy and safety of acupunctureVas, et al, (2006) conducted a study to establish the effectiveness of acupuncture vis a vis placebo. Both methods were to be utilized to treat chronic neck pains that were not complicated. (N=123) patients, who were over the ages 17 and who possessed chronic neck pains for over 3 months were used. They were randomly selected into 2 groups, the acupuncture group and placebo group. For 3 weeks, the acupuncture group was treated with 5 acupuncture treatments. The treatment characteristics were, 30 minutes treatment followed by 10 minutes manual treatments. While the placebo group was subjected to transcutaneous nerve stimulation, which was characterized by 30 minutes of treatment and the potentiometer was being adjusted after every 10 minutes.
The findings from this study were that, acupuncture as a form of neck treatment had minimal side effects. For overall effectiveness, acupuncture was found to have higher effectiveness than placebo. Researchers conclusively said that, acupuncture was effective.
DISCUSSIONIn its broad context, this research has dwelled in covering all the related material on acupuncture and especially its effectiveness in treatment of acupuncture. Most are the studies which have found considerable effectiveness and a few studies have found less significant improvement in acupuncture use. The researchers (salter et al, 2006; Liang et al 2012; Chen et al 2010; vas et al 2006) have favorably recognized acupuncture as an effective non-conventional treatment method.
From the review above, it is evident that all the methods of acupuncture are effective in treatment of chronic neck pains. Sham, optimization and shallow acupuncture all have a capacity of effectiveness when administered well. The various studies by salter have provided solid practical evidence and information on patients’ health upon using all the three types of acupuncture in treatment of patients and individuals (salter et al 2004). For example in 2007, a national health interview survey in America found that, 1.4% of respondents have used acupuncture to treat chronic neck pains. That percentage reported success, which is a testament to acupunctures effectiveness (National Center for Complementary and Alternative Medicine 2012).
(Blossfeldt, 2004) in his research notes that, acupuncture optimized technique success rate was a favorable 68%. Blossfeldt also noted that, on short term basis, acupuncture was 78% effective, while on long term basis it was 49% effective. Salter also found out on effectiveness of acupuncture. The neck pain questionnaire that he used for a period of 3 months, found out that, of the 34 % of the patients who have neck pains, 14% of these have effectively used acupuncture therapy (salter et al 2004) another researcher Liang, who conducted studies in china in association with other scholars, they found out that optimized acupuncture as a method of treating chronic neck pains was very effective.
Although I extensively performed research on a wide range of databases, there are some articles that may have been missed out. Since I was individually conducting this research alone, it is possible that the large number of crucial articles were subsequently overlooked. In addition, there are many external factors that could have influenced the entire result of the use of acupuncture as an ideal treatment for chronic neck pain. The majority of studies slightly differ in a number of issues such as data collected, population, or any of combinations of these factors. White (2001) precisely researched about the adverse events following a use of acupuncture to treat patients with chronic neck pain, with an extreme number of respondents. Chen, L. et al., (2010), had a relatively smaller number of responders, and also had collection of data to be collected only through email in his research on the effectiveness of acupuncture in the management of chronic pain in the neck. These are some of the factors that were out of the scope of the research, hence determining the effectiveness of acupuncture was difficult, since the aspect of effectiveness could easily be isolated from some external factors.
The analysis of the specific information provided by the studies of the literature review of this research paper indicates that either of the three methods of acupuncture can effectively treat the chronic neck pain. The procedural practice of sham, shallow and optimized acupuncture, though different, they present similar way of performing the acupuncture therapy, equally offering effective treatment for chronic neck pain. Liang et al, (2012) asserts that the three types of acupuncture to be based on the thought that decrease or alienation of pain can be enhanced by releasing the chemicals responsible for blocking pain. Issues of age in the study have been considered as the research only focused on individuals between 21 years old and 55 years, as they are likely to have a faster period of healing as compared to adult elderly groups of more than 55 years old. Generally, the use of acupuncture is illustrated as effective as it has previously been used to treat patients with chronic neck pain.
The loopholes evident in the research include the possibility of a prior knowledge in determining the differences that may emerge upon consideration for gender in the treatment program. In the entire study, there is no single explanation of the ratio of females against the males in finding out the effectiveness of acupuncture treatment procedures. The study focused on a general perspective of patients with chronic neck pain regardless of their respective sex or gender. The knowledge of the differences that exist between males and females could have some effects on the understanding the use of acupuncture. In addition, the paper did not focus on the causes of the various neck pain, which could also compromise the results of the study, considering that such plans are typically attributed to a wide variety of causes.
Topics that can be considered for further research are establishing the element of gender in determining the effectiveness of acupuncture while treating chronic neck problem. The various studies illustrated in the research paper did not point out the importance of understanding differences in the healing process of male and female patients with chronic neck pain. I suggest a study be conducted with a major emphasis on the aspect of gender differences between patients in order to determine the effectiveness of acupuncture treatment for neck pain in male and female patients. If this study is conducted, it will be possible to compare the effectiveness of acupuncture treatment between male and female patients within the same health condition of chronic neck pain.
Blossfeldt, P. (2004). Acupuncture for Chronic neck pain: a cohort study in an NHS pain Clinic.22(3): 146-151. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15551941Chen, L., Houghton, M., Seefeld, L., Malarick, C. & Mao.Jianren. (2010). A Survey of SelectedPhysician Views on Acupuncture in Pain Management. 11(4), 530-534
Salter, G.C, Roman, M., Bland, M. J & MacPherson, H. (2006). Acupuncture for chronic pain: apilot for randomized controlled trial. 7(1): 3-14. Retrieved fromhttp://www.biomedcentral.com/1471-2474/7/99
Liang, Z. H., Di, Z., Jiang, S., Xu, S. J., Zhu, X. P., Fu, W,.& Lu, A. P. (2012). The optimizedacupuncture treatment for neck pain caused by cervical spondylosis: a study protocol of amulticenter randomized controlled trial. 13(1): 2-18. Retrieved fromhttp://www.ncbi.nlm.nih.gov/pubmed/22776567
American Academy of Orthopaedic Surgeons.(2013). neck pain. Retrieved fromhttp://orthoinfo.aaos.org/topic.cfm?topic=a00231Chen, L., Houghton, M., Seefeld, L., Malarick, C., & Mao, J. (2010).a survey of selected physician views on acupuncture in pain management. Pain Medicine, 11(4), 530-534. Retrieved from SPORTDiscus.
De Loose, V., Burnotte, F., Cagnie, B., Stevens, V., & Van Tiggelen, D. (2008). Prevalence and risk factors of neck pain in military office workers. Military Medicine, 173(5), 474-479. Retrieved from Academic Search Premier.
Hush, J. M., Michaleff, Z., Maher, C. G., &Refshauge, K. (2009). Individual, physical and psychological risk factors for neck pain in Australian office workers: a 1-year longitudinal study. European Spine Journal, 18(10), 1532-1540. Retrieved from Academic Search Premier.
Irnich, D., Behrens, N., Gleditsch, J. M., Stör, W., Schreiber, M. A., Schöps, P., & … Beyer, A. (2002). Immediate effects of dry needling and acupuncture at distant points in chronic neck pain: results of a randomized, double-blind, sham-controlled crossover trial. Pain (03043959), 99(1/2), 83.Retrieved from Academic Search Premier.
Ji-Eun, P., MyeongSoo, L., Jun-Yong, C., Bo-Young, K., & Sun-Mi, C. (2010). Adverse Events Associated with Acupuncture: A Prospective Survey. Journal Of Alternative & Complementary Medicine, 16(9), 959-963. Retrieved by Academic Search Premier.
National Center for Complementary and Alternative Medicine. (2012). Acupuncture: an introduction. Retrieved from http://nccam.nih.gov/health/acupuncture/introduction.htmNational Institutes of Health.(2013). neck pain.Retreived from http://www.nlm.nih.gov/medlineplus/ency/article/003025.htmRobertshawe, P. (2008). Acupuncture and physiotherapy for neck tension.Journal Of The Australian Traditional-Medicine Society, 14(3), 187. Retrieved from Academic Search Premier.
Sun, M., Hsieh, C., Cheng, Y., Hung, H., Li, T., Yen, S., & Huang, I. (2010). The therapeutic effects of acupuncture on patients or individuals with chronic neck myofascial pain syndrome:: a single-blind randomized controlled trial. American Journal Of Chinese Medicine, 38(5), 849-859. Retrieved from Academic Search Premier.
Vas, J., Perea-Milla, E., Méndez, C., Navarro, C., León Rubio, J., Brioso, M., &Obrero, I. (2006). Efficacy and safety of acupuncture for chronic uncomplicated neck pain: A randomised controlled study. Pain (03043959), 126(1-3), 245-255. Retrieved from Academic Search Premier.
White, A. (2001). Adverse events following acupuncture: prospective survey of 32,000 consultations with doctors and physiotherapists. 10(1), 3-14 Retrieved from BMJ Research Articles
Willich, S. N., Reinhold, T., Selim, D., Jena, S., Brinkhaus, B., & Witt, C. M. (2006).Cost-effectiveness of acupuncture treatment in patients or individuals with chronic neck pain.Pain (03043959), 125(1/2), 107-113. Retrieved from Academic Search Premier
Witt, C. M., Jena, S., Brinkhaus, B., Liecker, B., Wegscheider, K., &Willich, S. N. (2006). Acupuncture for patients or individuals with chronic neck pain. Pain (03043959), 125(1/2), 98-106. Retrived from Academic Search Premier.