Acupuncture for 'frequent attenders' with medically unexplained symptoms: a randomised controlled trial (CACTUS study)

Paterson, Charlotte, Taylor, Rod S., Griffiths, Peter, Britten, Nicky, Rugg, Sue, Bridges, Jackie, McCallum, Bruce and Kite, Gerad (2011) Acupuncture for 'frequent attenders' with medically unexplained symptoms: a randomised controlled trial (CACTUS study). British Journal of General Practice, 61 (587), e295-e305. (doi:10.3399/bjgp11X572689).

Abstract

Background:

Medically unexplained physical symptoms (MUPS) are common and difficult to treat.

Aim:

To investigate the effectiveness of adding five-element acupuncture to usual care in ‘frequent attenders’ with MUPS.

Design and setting:

Randomised controlled trial in four London general practices.

Method:

Participants were 80 adults with MUPS, consulting GPs ?8 times/year. The intervention was individualised five-element acupuncture, ?12 sessions, immediately (acupuncture group) and after 26 weeks (control group). The primary outcome was 26-week Measure Yourself Medical Outcome Profile (MYMOP); secondary outcomes were wellbeing (W-BQ12), EQ-5D, and GP consultation rate. Intention-to-treat analysis was used, adjusting for baseline outcomes.

Results:

Participants (80% female, mean age 50 years, mixed ethnicity) had high health-resource use. Problems were 59% musculoskeletal; 65% >1 year duration. The 26-week questionnaire response rate was 89%. Compared to baseline, the mean 26-week MYMOP improved by 1.0 (95% confidence interval [CI] = 0.4 to 1.5) in the acupuncture group and 0.6 (95% CI = 0.3 to 0.9) in the control group (adjusted mean difference: acupuncture versus control –0.6 [95% CI = –1.1 to 0] P = 0.05). Other between-group adjusted mean differences were: W-BQ12 4.4 (95% CI = 1.6 to 7.2) P = 0.002; EQ-5D index 0.03 (95% CI = –0.11 to 0.16) P = 0.70; consultation rate ratio 0.90 (95% CI = 0.70 to 1.15) P = 0.4; and number of medications 0.56 (95% CI = 0.47 to 1.6) P = 0.28. All differences favoured the acupuncture group. Imputation for missing values reduced the MYMOP adjusted mean difference to –0.4 (95% CI = –0.9 to 0.1) P = 0.12. Improvements in MYMOP and W-BQ12 were maintained at 52 weeks.

Conclusion:

The addition of 12 sessions of five-element acupuncture to usual care resulted in improved health status and wellbeing that was sustained for 12 months.

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Contributors

Author: Peter Griffiths

Author: Jackie Bridges

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