A meta-analysis of the effectiveness of acupuncture in smoking PowerPoint Presentation

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SMOKING CESSATION METHODS NOT BASED ON SCIENTIFIC EVIDENCE Cengiz ÖZGE, Associate Professor. Mersin University Faculty of Medicine Department of Chest Disease

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Contents Introduction Electronic Cigarette Acupuncture and associated methods Hypnosis

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Among Cigarette Smokers 70% wants to quit smoking. 35% seriosly attempted to quit in the last year. 80% previosly attempted to quit. 3% manages to quit in a year.

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Quit in a single setting Success more than 90% Refund of money is guarantee

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What is the scientific evidence ?

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WHY ME ?

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Meta analysis Randomised controlled trials Cohort studies Case-control studies Case-report “Editorial”, clinical opinion...etc. animal studies, in vitro studies...etc. Evidence Pyramide

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SCIENTIFIC EVIDENCE

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Electronic cigarette

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Electronic cigarette A Commercial product of tobacco. Certified by the Ministry of Agriculture. Not designed for smoking cessation therapy. No presented scientific study.

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Acupuncture Have a history of 3000 years. Have been in Europe since 1600ths. Chen-Chin : Needle-Heat Acus: Needle Punctura: Prick

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Acupuncture There are almost 1000 stimulation points in the human body. 650-700 of these points are being used. It is beleived that there is an acapunture point for every organ in the ear.

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Mechanisms of the effects of Acapuncture The body has two opposite energy called Yin and Yang working in synergy. This energy travels in the canals called meridians. If the balance fall off, an abnormaly ensues. Acapuncture helps to maintain this balance.

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Theory of five elements Wood,fire, earth, metal and water. All the phenomenon in the universe structurally meets these five elements. They are in a continuous movement and alteration. If this balance is falls off diseases ensue. Acapuncture maintains this balance

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Mechanisms of the effects of Acapuncture Endorphine Met-encephalin Serotonine Dopamine

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Fields of administration of acupuncture Cure of pain Apettite control and slimming Reduction of Stress Acceleration of metabolism. Treatment of allergy. Migrene and headache. Treatment of Insomnia. Cessation of smoking.

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Acupuncture Auricular acupuncture Moxibustion Acupressure Electro Acupuncture LASER Akapunktur Luxopuncture Bioresonance Moratherapy

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Moxibustion Application of heat to the acupuncture points instead of needles. Electro Acupuncture LASER Acupuncture Electric current LASER irradiation Acupressure Pressure application onto the acupuncture points.

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Luxopuncture Developed in France Condensed infra red light application to the acupuncture points.

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Bioresonance Moratherapy Plain electrode contact on the human skin at certain sites Electromagnetic vibration. Depends on the claim that faint low frequency vibrations carry knowledge.

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R.I.S.E Reflection Instrument Scanning Electro-pulse I quit smoking (IQS) Beta-endorphine

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A meta-analysis of studies into the effect of acupuncture on addiction G TER RIET, J KLEIJNEN, P KNIPSCHILD British Journal of General Practice, 1990, 40, 379-382. Between 1963-1989 Total of 27 studies 15 of them for smoking cessation.

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A meta-analysis of studies into the effect of acupuncture on addiction G TER RIET, J KLEIJNEN, P KNIPSCHILD British Journal of General Practice, 1990, 40, 379-382.

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A meta-analysis of studies into the effect of acupuncture on addiction G TER RIET, J KLEIJNEN, P KNIPSCHILD British Journal of General Practice, 1990, 40, 379-382.

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A meta-analysis of the effectiveness of acupuncture in smoking cessationASHENDEN R, SILAGY CA, LODGE M, FOWLER G. Drug and Alcohol Review (1997) 16, 33-40 Have at least two therapy groups, Randomized No old (previous) control group is used. 9 studies are taken into consideration A total of 2707 patients.

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A meta-analysis of the effectiveness of acupuncture in smoking cessationASHENDEN R, SILAGY CA, LODGE M, FOWLER G. Drug and Alcohol Review (1997) 16, 33-40 Total (95% CI) OR: 1.48 (CI:1.13-1.48)

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A meta-analysis of the effectiveness of acupuncture in smoking cessationASHENDEN R, SILAGY CA, LODGE M, FOWLER G. Drug and Alcohol Review (1997) 16, 33-40 Acupuncture seems to be better according to the control group; *HOWEVER!! NOT better than the Sham acupuncture. ( OR:1.16 % 95 CI: 0.90-1.49)

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A meta-analysis of the effectiveness of acupuncture in smoking cessationASHENDEN R, SILAGY CA, LODGE M, FOWLER G. Drug and Alcohol Review (1997) 16, 33-40

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A meta-analysis of the effectiveness of acupuncture in smoking cessationASHENDEN R, SILAGY CA, LODGE M, FOWLER G. Drug and Alcohol Review (1997) 16, 33-40 All are self-reports, no CO measurements Only 4 studies have 12 months of follow up. 4 studies single-blind, 5 studies open. Studies are small. Methodological scores are low.

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Randomized controlled studies Acupuncture Acupressure LASER acupuncture Electrostimulation Sham acupuncture 24 studies were evaluated White AR, Rampes H, Campbell J. Acupuncture and related interventions for smoking cessation.Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD000009

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White AR, Rampes H, Campbell J. Acupuncture and related interventions for smoking cessation.Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD000009

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White AR, Rampes H, Campbell J. Acupuncture and related interventions for smoking cessation.Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD000009 No high quality studies about acupunture and associated applications are present No prominent dominancy in a year’s follow up. The effectivness that was seen in the early period was abated by the removal of a study which was conflicting with the homogenicity of the study.

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Alternative therapies for tobacco dependenceL.M. Villano, A.R. White / Med Clin N Am 88 (2004) 1607–1621

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A Randomized Controlled Clinical Trial of Auricular Acupuncture in Smoking CessationTa-Peng Wu, Fang-Pey Chen, Jui-Yao Liu, Ming-Hsien Lin, Shinn-Jang HwangJ Chin Med Assoc • August 2007 • Vol 70 • No 8

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ACUPUNCTURERESULT There are no scientific evidence for the effectivess of Acupuncture, Acupressure, LASER acupuncture and Electrostimulation to be used for the cessation of smoking.

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HYPNOSIS HYPNOSE: The name of the God of Sleeping in Greek Mythology. This is a state of bringing someone into a deeply sleeping like situation where his/her behaviour can be kept under control by another person.

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HİPNOZ A state of sleeping achieved by words, looks and suggestions. A person in this state (subject) is open to the suggestions and influences of the applying person but closed to the other stimulations from the surrounding.

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HypnosisHistory Before the holy books, sorcery and medicine were used together in religious ceremonied. In 1778 Dr.Franz Mesmer In 1847 for quitting tobacco In 1958 American Medical Association approved Medical hypnosis.

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HYPNOSISFields of Application-1 Depression Social phobia (zoophobia, acrophobia, hydrophobia) Tic disorders  Stammer  Enuresis nocturna, Psycological pain disorders.  Obesity Anorexia, Blumia  Alcohol and tobacco addiction  Panic attack.

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HYPNOSISFields of Application-2 Conversion Disorders  Posttraumatic Stress Disorders Psycologic Memory losses Sleep Disorders Bruxism Sexual Functional Disorders (Impotence, premature, ejaculation, vaginusmus) Onichophagia Obsession Personality Disorders

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HYPNOSISFields of Application-3 Psycological tremors Dyslexia Cure of chronic physical pain. Painless child delivery Trigeminal Neuralgia. Nervous Hypertension Asthma Allergic Skin Disorders. Psoriasis Treatment of the wharts. Migraine,  Attenuation of pain due to cancer  Treatment for the teeth without application of anesthesia.

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Hypnosis and Cessation of Smoking Its means of effect is not clear. Relaxation, Extreme suggestibility Hightened imagination proposed to act on the underlying impulses. Inhibition of the left cerebral hemisphere

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Hypnosis and Smoking Cessation 1st Session: Interview, understanding hypnosis, being hypnotized. 2nd and 3rd Session: Administering regression hypnotherapy to eliminite obstacles to quitting smoking; uncovering unconscious reason cousing smoking.4th. Session: Direct suggestion session(Changing unconscious patterns causing smoking. Replasing with new habits.) 5th Session: Ego strengthening hypnosis session (Strengthening positive emotions such as focusing on future, self-confidence self-esteem in the person who quitted smoking.) 6th Session: Learnig self-hypnosis and EFT techniques (Teaching daily techniques that will be used to preserve wellness consistently)

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Cochrane Database of Systematic Reviews Hypnotherapy for smoking cessation (Review) Abbot NC, Stead LF, White AR, Barnes J 1998, Issue 2 Last assessed as up-to-date: 15 February 2005. Between 1966-2005. 28 studies are found. appraisable 9 studies. 19 studies were excluded. Randomized. Follow up at least for 6 months.

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Cochrane Database of Systematic Reviews Hypnotherapy for smoking cessation (Review) Abbot NC, Stead LF, White AR, Barnes J 1998, Issue 2 Last assessed as up-to-date: 15 February 2005.

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Exclusion Criteria . . Cochrane Database of Systematic Reviews Hypnotherapy for smoking cessation (Review) Abbot NC, Stead LF, White AR, Barnes J 1998, Issue 2 Last assessed as up-to-date: 15 February 2005.

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Cochrane Database of Systematic Reviews Hypnotherapy for smoking cessation (Review) Abbot NC, Stead LF, White AR, Barnes J 1998, Issue 2 Last assessed as up-to-date: 15 February 2005.

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Cochrane Database of Systematic Reviews Hypnotherapy for smoking cessation (Review) Abbot NC, Stead LF, White AR, Barnes J 1998, Issue 2 Last assessed as up-to-date: 15 February 2005.

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Cochrane Database of Systematic Reviews Hypnotherapy for smoking cessation (Review) Abbot NC, Stead LF, White AR, Barnes J 1998, Issue 2 Last assessed as up-to-date: 15 February 2005.

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Hypnosis for smoking cessation: A randomized trialTimothy P. Carmody, Carol Duncan, Joel A. Simon, Sharon Solkowitz,Joy Huggins, Sharon Lee, Kevin Delucchi Nicotine & Tobacco Research Volume 10, Number 5 (May 2008) 811–818 Total of 286 patients 2 grups: Hypnosis and behevioral counseling. HYPNOSIS:Face to face for 60 minutes, two seance. Behavioral counseling: Face to face for 60 minutes, two times and follow up by telephone on the 3rd, 4th, 6th, weeks.

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Hypnosis for smoking cessation: A randomized trialTimothy P. Carmody, Carol Duncan, Joel A. Simon, Sharon Solkowitz,Joy Huggins, Sharon Lee, Kevin Delucchi Nicotine & Tobacco Research Volume 10, Number 5 (May 2008) 811–818

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Hypnosis for smoking cessation: A randomized trialTimothy P. Carmody, Carol Duncan, Joel A. Simon, Sharon Solkowitz,Joy Huggins, Sharon Lee, Kevin Delucchi Nicotine & Tobacco Research Volume 10, Number 5 (May 2008) 811–818 CONCLUSION May be more effective if hypnosis and nicotine bands are concomittantly used. Future studies are necessary for the investigation of effectivness of such therapies.

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HİPNOZ CONCLUSION There are NO scientific evidence describing the effect of hypnosisi for the cessation of smoking!!!

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Allen Carr’s method Allen Carr’s Easyway removes the need and desire to smoke. No NRT No needles No LASER No drugs! No herbs No shock treatment NO Scientific Evidence!!

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There are no treatment methods with over 90% success rates in today’s practice. The only scientifically evident method of treatment is the Supportive Therapy with pharmacological therapy The pharmacological therapeutic agents whose effectivness are approved are: Nicotine replacement therapies, Bupropion and Varenicline.

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Thanks for your patients