Steel_subbed.qxp 7/8/09 4:00 pm Page 42
Smoking Cessation
Figure 1: CONSORT Diagram – Articles Identified inserted, usually into two points in the ear, and held in position
for Acupuncture
with surgical tape for several days. Patients are then instructed to
press on these needles when they become aware of any withdrawal
(Smoking cessation) and (acupuncture) via
PubMed search engine symptoms. Acupressure and low-level laser therapy have also been
used as alternatives to needles in stimulating acupuncture points.
84 articles identified
Several review articles looking at controlled trials of acupuncture and
smoking cessation have been published, the most recent being the
68 English language articles reviewed
Cochrane review in 2006.
8
However, varying methodology and
inconsistent results between studies have made interpretation of the
14 articles included: 54 articles excluded: results difficult. Early uncontrolled studies were promising, suggesting
1 recent Cochrane review
7
32 articles unrelated to acupuncture
quit rates of 34% at 12 months with acupuncture.
9
This has not been
8 studies included in the most 2 case control studies, not borne out by randomised studies involving acupuncture compared
recent Cochrane review randomised
3 studies since the Cochrane 3 articles on acupuncture in other
with sham acupuncture. Sham acupuncture involves two possible
review
11–13
conditions techniques: needling an area that is not a recognised acupoint or
1 meta-analysis on acupuncture 2 articles on acupuncture
techniques abstinence in unspecified conditions
needling a point that is believed to be ineffective for the condition
1 exploratory meta-analysis on 3 articles on auricular acupuncture,
being treated.
the effects of auricular acupuncture full text unavailable
depending on the points chosen
9
1 article with laser acupuncture,
full text unavailable
The main problem with randomised controlled studies in acupuncture
1 non-randomised study with
4-week follow-up only
remains the methodology employed. Sham acupuncture has been
1 article on genetic differences
criticised as it is possible that inserting a needle in any location may
accounting for variable acupuncture
response
have a physiological effect regardless. Thus, the process actually
4 letters
compares two active treatments instead of an active treatment and
1 review article looking at
neurotransmitter levels following placebo. A recent meta-analysis suggests that there may be no
acupuncture
4 meta-analyses that had been
difference between treatment at ‘correct’ points and ‘incorrect’ points.
10
included in the most recent This also suggests that the negative result of the comparison between
Cochrane review
acupuncture and sham acupuncture may conceal a true effect.
Figure 2: CONSORT Diagram – Articles Identified
The Cochrane review found that results from a meta-analysis
for Hypnotherapy of randomised controlled trials with long-term outcomes (six months to
one year) did not show a significant benefit of acupuncture
(Smoking cessation) and (hypnotherapy) via
over sham acupuncture. However, evidence from combining
PubMed search engine
randomised controlled trials with short-term outcomes (up to six weeks
from the quit date) suggests that acupuncture may be more effective
88 articles identified
than both no treatment or sham acupuncture (odds ratio [OR] 1.36, 95%
confidence interval [CI] 1.07–1.72). These results relied heavily on a
76 English language articles reviewed single positive study by Lacroix and Besancon in 1977, where 117
smokers showed an OR of 7. There is no obvious reason for this
exceptional result. However, the heterogeneity of the studies pooled
11 articles included: 65 articles excluded:
made it impossible to conclude consistently that there was indeed a
2 review articles
18
35 articles unrelated to hypnosis
1 meta-analysis of gender-based 13 articles on hypnosis in other
short-term benefit. This review also compared acupuncture with no
differences in hypnosis for smoking clinical settings intervention, other interventions (e.g. NRT or counselling and
cessation
24
1 comment
6 randomised controlled studies 3 review articles, prior to
psychological approaches) and its use as an adjunct therapy. In each of
included in the Cochrance Cochrane analysis these instances, no significant benefit was observed with acupuncture.
review
19–22
1 study, all groups received
1 study looking at predictors of hypnotherapy
smoking abstinence following 5 brief communications
Although most studies use auricular acupuncture, other researchers use
hypnosis
17
2 descriptive studies
1 field study looking at gender 3 non-randomised studies:
body acupuncture sites for nicotine withdrawal symptoms. The sites for
differences in hypnosis
25
hypnotherapy and smoking ban
control studies vary considerably. Furthermore, the frequency of
workplace intervention
hypnotisability and smoking
acupuncture sessions in the intervention arm also varied greatly from
outcome
study to study. Only one study used acupuncture/sham acupuncture
3-session hypnosis intervention
in all participants
daily, alone or in combination with an educational cessation programme,
2 clinical follow-up studies
and showed a short-term beneficial effect, but this was not sustained at
18 months.
11
However, there was a significant correlation in all groups
Subsequent acupuncture procedures were developed from their initial between estimated smoking pack-year history and decrease in cigarette
protocol, which used electroacupuncture on two ear points. use following acupuncture treatment. This relationship was strongest in
the true acupuncture and smoking cessation group education group,
With regard to smoking cessation, there are two basic techniques suggesting that there may be a potential benefit in a combination
involving acupuncture: needles may be inserted for the duration of treatment protocol for those at greatest addiction risk. The main
the treatment session (15–20 minutes) and repeated over the limitations in this study were the high drop-out rate and the lack of
following days, or specially designed indwelling needles may be biochemical validation for smoking cessation.
42 EUROPEAN RESPIRATORY DISEASE
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