How do patients choose acupuncturists? A mixed methods project

ARTICLE IN PRESSAbstracts / European Journal of Integrative Medicine 1 (2009) 223–260238

down-regulatory opiate alkaloids (e.g., morphine). Usually,relaxation is a result of the systemic down-regulation thatoccurs after stress response pathways get shut-down, followingtheir initial induction. As pain occurs in the primary phase ofthis process, it gets an inhibitory push-back under the influenceof endorphins and other analgetic endogenous signalingmolecules in this still early, i.e., stress response-associatedstage. The rationale of this phase would be that the ‘stressed’organism chiefly fights against the stressor and then, subse-quently, cares about the possible wounds and traumasacquired. These secondary processes include endogenousmorphine signaling, allowing the pain to come back again,yet in an altered and more ‘distant’ way, enabling the organismto face it and decide upon necessary actions for recovery andlearning. This secondary phase also reduces over-stimulation,e.g., of the immune system, involving anti-inflammation.Hence, down-regulation serves recovery, i.e., systemic back-up. Stress induction and subsequent termination follow eachother automatically and naturally, i.e., ideally, thereforeactivating, among others, endogenous limbic reward andmotivation circuitries. However, little is known about theinterplay between pain perception and its relationship withcatecholamine molecules other than dopamine serving as anendogenous morphine precursor. We believe that the percep-tion of pain and the body’s self-attempt to alleviate it, utilizingconventional homeostatic mechanisms, is mediated by keycatecholamines, and that this effect is further modulated bynitric oxide. We further propose a paradigm which biologicallylinks pain, autoregulation, endogenous morphine and thecatecholamines together, demonstrating a complex symbioticsignalling system. Integrative, complementary and mind–bodymedicine would, by their nature, include this paradigm in theirunderlying concepts and therapeutic strategies.Keywords: Stress; Trauma; Autoregulation; Limbic system; Motivation;

Morphine; Endorphins; Catecholamines; Nitric oxide

10.1016/j.eujim.2009.08.029

PO-027

How do patients choose acupuncturists? A mixed methods

project

F. Bishop, Y. Massey, G. Lewith

University of Southampton, School of Medicine, South-

ampton, United Kingdom

Question: Government policy is to develop statutoryregulation of complementary medicine practitioners inthe UK. Acupuncturists are not yet subject to statutoryregulation and hence potential patients face difficultdecisions. A qualitative study explored patients’ experi-ences. A quantitative vignette study investigated the impactof 3 practitioner-factors (gender, training location, quali-fications) and 1 patient-factor (gender).

Methods: Qualitative study: 35 acupuncture patients wererecruited from 7 clinics and the community (maximum

variation sampling). Semi-structured interviews about theirexperiences of acupuncture were recorded, transcribed, andanalysed using thematic analysis.Quantitative study: 83 participants imagined wanting toconsult an acupuncturist for persistent back pain. Theyrated 8 fictional acupuncturists.

Results: Acupuncture patients were concerned to findtrustworthy acupuncturists and valued personal recom-mendations from trusted others. In the absence of suchrecommendations potential patients preferred female acu-puncturists (F(1,76) ¼ 30.63, po.01) with medical qualifi-cations (F(1,76) ¼ 125.72, po.01), who trained in China(F(1,76) ¼ 8.53), po.01).

Conclusions: People are concerned about the trustworthi-ness and authenticity of acupuncturists. (Potential) patientsneed to be clearly informed about statutory regulation andits implications, and GPs could better support theirpatients in choosing complementary medicine practi-tioners.

10.1016/j.eujim.2009.08.030

PO-028

Application and subjective benefit of Crataegus extracts in

patients with incipient heart failure with regard to perfor-

mance and quality of life—A qualitative study

P.W. Guendling, E. Mesenholl-Strehler

Hochschule Fresenius, Lehrstuhl fur Naturheilkunde und

komplementare Medizin, Idstein, Germany

Background: Heart failure is one of the most common andmost expensive chronic diseases in western industrial countries.And it is increasing because of the demographic development.While the effect of standardized Crataegus extracts for heartfailure NYHA I-II is well proven [1], these results do not allowdetailed conclusions about how the use of Crataegus extractinfluences quality of life and everyday life of patients with heartfailure in an early state and how its personal benefit isestimated from a patient’s point of view [2].

Methods: Descriptive interview study with 3 groups of patientswith heart failure in an early stage and with vs. without intakeof a standardized Crataegus extract for at least 90 days. Intotal 40 patients were randomised from a patients’ file of ageneral practitioner and in order to maximize the variance ofthe probability distribution another 20 patients with the samerequirements were acquired by advertisement. The severity ofheart failure was estimated by screenings (history, Goldman’sSpecific Activity Scale and NYHA criteria), pattern ofutilisation and concepts of usefulness were collected by asemi-structured interview guide. Additionally the general andheart specific quality of life was evaluated by SF-36 andKansas City Cardiomyopathy Questionaire (KCCQ) and thecomorbid depression by PHQ-D.