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Therapies

acupuncture

What Is It?
How Does It Work?
What You Can Expect
Health Benefits
How To Choose a Practitioner
Cautions
References

Evidence Based Rating System 

 

What Is It?

Acupuncture is an ancient technique in which a skilled practitioner inserts hair-thin needles into specific points on the body to prevent or treat illness. Practiced for over 2,500 years in China, where it originated, acupuncture is part of the holistic system of traditional Chinese medicine (TCM), which views health as a constantly changing flow of energy, or qi (pronounced "chee"). In TCM, imbalances in this natural flow of energy are thought to result in disease. Acupuncture aims to restore health by improving the flow of qi.

The earliest references to acupuncture can be found in The Yellow Emperor’s Classic of Internal Medicine (the Huang Ti Nei Ching) which dates back to the second century BC. Acupuncture only appeared in  Western medical texts approximately one hundred years ago (Sir William Osler's Principles and Practice of Medicine, published in 1892, recommended it for sciatica and lumbago). However, it wasn't until 1971 that U.S. citizens really became aware of the technique. It was then that New York Times reporter James Reston, stricken with appendicitis while in Beijing, was treated successfully with acupuncture for post-surgical pain. In a front page Times story, Reston wrote, "I've seen the past, and it works!"

This exposure came at a time when many Americans were looking for a more holistic, naturalistic approach to health care, and it caused quite a stir among the Western medical community. Since then acupuncture has become a widely accepted form of treatment in the U.S., practiced by M.D.s, D.O.s (osteopathic physicians), D.C.s (chiropractic physicians), and N.D.s (naturopathic physicians) who have received special training in its methods, as well as by professionally trained acupuncture practitioners (L.Ac.s, M.Ac.s, O.M.D.s), who specialize only in acupuncture and related traditional Chinese medicine (TCM) therapies.

How Does It Work?

According to the principles of TCM, qi flows through the body via 12 primary meridians or channels. To strengthen the flow of qi, or remove blockages in the meridians, an acupuncturist inserts a number of tiny, sterile, flexible needles just under the skin at certain specific points (called acupoints) along the channels. There are four to five hundred named acupoints along the meridians, some of which are associated with specific internal organs or organ systems. If you are suffering from nausea, for example, needles might be inserted into acupoints on your wrist, while a vision problem might be treated with needles in the foot. (Additional ear, scalp, and hand points are also commonly used by some practitioners.) Acupuncture practitioners believe that the therapy stimulates the body's internal regulatory system and nurtures a natural healing response.

Although Western science has neither proven nor accepted the notion of qi, a large body of evidence is accumulating indicating that acupuncture leads to real physiologic changes in the body. Numerous studies have shown, for example, that inserting needles into the skin stimulates nerves in the underlying muscles. This stimulation, researchers postulate, sends impulses up the spinal cord to a relatively primitive part of the brain known as the limbic system, as well as to the midbrain and the pituitary gland. Somehow that signaling leads to the release of endorphins and monoamines, chemicals that block pain signals in the spinal chord and brain.

In one study, researchers using brain scans discovered that acupuncture can alter blood circulation within the brain, increasing the blood flow to the thalamus, the area of the brain that relays pain and other sensory messages.

Hundreds of studies are now ongoing in the United States and elsewhere seeking to prove the usefulness of acupuncture for various ailments.

What You Can Expect

On your first visit to an acupuncturist, the practitioner will take a thorough medical history, then may assess three pulses on each wrist, examine your tongue, take note of how your breath and body smell, and "palpate" (or feel) certain areas of your body. Depending on your ailment, you may also have your first acupuncture treatment at this time. In general, visits occur once or twice a week over several months until therapeutic results are achieved.

While the needles can feel uncomfortable at times, they rarely hurt. They are very thin (only about three times the thickness of a human hair and much finer than the hypodermic needles used to give injections) and are designed to enter the skin with little resistance. Once the needles are inserted (generally from one to 15 are used), the acupuncturist may twist them manually or send a weak electrical current through them to increase the energy flow. The needles may be left in for 15 to 40 minutes, depending on the ailment. Some practitioners also use moxibustion, which involves heating the needles or acupoint with a slowly burning herbal agent (primarily the dried herb mugwort) to hasten healing.

Different people experience different sensations from acupuncture. Some describe a tingling pins-and-needles feeling, others may feel numbness or nothing at all. Most find the sessions relaxing, and many fall asleep during or immediately after treatment.

Some patients notice rapid improvement after just a few sessions. In those whose conditions have taken years to develop, treatment may take longer.

Health Benefits

While scores of illnesses have traditionally been treated by acupuncture in Asia, its primary use in the United States has been to relieve chronic pain--caused by such ailments as arthritis, headache, PMS, and back pain--and to assist withdrawal from addictions such as drug and alcohol dependency. Today more innovative applications for acupuncture are being explored by both conventional and alternative practitioners, including its use as an analgesic to reduce pain during surgery.

In 1997, an advisory panel for the National Institutes of Health (NIH) evaluated hundreds of acupuncture studies and concluded that the therapy is an effective treatment for postoperative pain after dental surgery and for nausea induced by chemotherapy, pregnancy ("morning sickness"), and anesthesia. Today scientists are studying acupuncture’s effects on everything from back pain, to breech birth, to irritable bowel syndrome. It seems that the practical applications of this therapy are expanding everyday.

Doctors are often have very little to offer patients undergoing stroke rehabilitation therapy. Research is now beginning to examine how acupuncture may be able to benefit these difficult cases. Preliminary data shows that acupuncture may be more beneficial than control interventions, and may also useful as an adjunct to conventional stroke rehabilitation treatment (1, 2). However, this research still has a long way to go to be able to garner reliable results. More studies with higher quality research design are needed to fully validate these effects.

There exists a mounting body of evidence for the use of acupuncture in the treatment of chronic pain. A criterion-based review of 51 controlled trials of acupuncture for the treatment of chronic pain found 24 trials reporting results favoring acupuncture (3). However, most of these studies showed conflicting results or were of small size or low quality. More research is necessary to distinguish the possible benefits of acupuncture for chronic pain conditions. Other studies of auricular acupuncture for cancer pain, for chronic epicondylitis, for chronic neck pain, and for back pain show that acupuncture may be of benefit (4-8).

A small trial conducted by researchers in Norway found that acupuncture treatment reduced chronic neck and shoulder pain up to three years after the last treatment was administered (9). Further research is needed to validate these findings and assess the number of treatments needed to instill long term benefits.

 

Acupuncture is also being investigated as a useful therapy for the treatment of osteoarthritis. Nearly 21 million people in the U.S. alone are plagued by this debilitating condition. Currently many studies are seeking to determine if acupuncture is beneficial in relieving the pain and disability caused by this degenerative condition. As with other conditions, study results on the effectiveness of acupuncture for osteoarthritis are not consistent. A systematic review including seven trials of acupuncture for knee osteoarthritis failed to show a beneficial effect greater than placebo (10). However, these studies were of varying quality, duration, and size. Other studies show acupuncture to be a useful adjunct to drug therapy (11). Recent smaller trials suggest that acupuncture for osteoarthritis of the knee can bring significant pain and symptom relief either alone or as an adjunctive therapy (12). 

In the largest scale trial of acupuncture for osteoarthritis to date, researchers at the University of Maryland Baltimore recently demonstrated that acupuncture for osteoarthritis of the knee is both safe and effective (13). In their study published in the Annals of Internal Medicine, the research team compared the efficacy of true acupuncture, to sham acupuncture, and patient education. At twenty-six weeks the true acupuncture group showed significant improvements over the other conditions on measures of pain, function, and global improvement.

 

A quickly expanding body of evidence also supports the use of acupuncture in the treatment of chronic headaches. A study conducted on 401 patients being treated by their family doctor for migraine, or tension type headaches found that the patients who received acupuncture showed persistent clinical benefits that lead to a better quality of life, when compared to the non-acupuncture group (14).

 

There is a persuasive body of evidence to recommend acupuncture as a treatment for post-surgical dental pain (15, 16). Likewise, there is significant evidence demonstrating the effectiveness of acupuncture in the treatment of pregnancy-induced, chemotherapy-induced, and

postoperative nausea and vomiting (17-19). Acupuncture may also be useful to relieve aches and pains during pregnancy, which would be a great benefit as many women abstain from medication at this time (20). You should discuss the decision to see an acupuncturist for any condition with your physician. They can help to refer you to a credible practitioner as well as coordinate a treatment plan that reflects your personal values and wishes. Acupuncture is an ancient modality that is only beginning to be systematically investigated and reviewed in the West. The coming years will no doubt greatly enhance our understanding of the benefits of this versatile therapy.

 

Note: To date, studies have failed to show evidence advocating acupuncture in the treatment of nicotine, alcohol, or drug addiction. Acupuncture should not replace conventional therapies in the treatment of these conditions (20-22).

 

How To Choose a Practitioner

There are an estimated 13,000 licensed and certified acupuncturists in the United States. Most states allow physicians to perform this procedure (the basic level of acupuncture training for medical acupuncturists is a 200- to 300-hour course). It's best to look for a physician acupuncturist who meets specific state acupuncture requirements, who is a practicing member of the American Academy of Medical Acupuncture (AAMA) in Los Angeles, CA, and/or is certified by the American Board of Medical Acupuncture.

Professional acupuncturists (L.Ac is the usual title) are licensed in 39 states and the District of Columbia. Standards are becoming more uniform across the country, but in some states acupuncturists were initially "grandfathered" into licensure status without meeting the current, more rigorous standards. It is therefore important to get a referral from your doctor and check that your practitioner has been certified by The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) in Alexandria, Virginia, and seeks continuing education in the field.

Naturopathic physicians (N.D.s) and chiropractic physicians (D.C.s) should have at least 200 hours of acupuncture training and be approved by their state licensing boards in order to practice acupuncture in their state.

Cautions

·  Fainting upon insertion of needles is the most common of the few side effects of acupuncture. If you have had such difficulty with shots or blood drawing, try to come to your first acupuncture treatment as relaxed as possible and ask your practitioner to do a light treatment the first time.

·  Hepatitis B and other contagious diseases can be transmitted from needles that aren't sterilized properly. A reputable practitioner will only use disposable needles.

·  Stimulating certain acupuncture points, particularly those on the lower abdomen and low back, can trigger uterine contractions and could induce premature labor and possibly miscarriage. On the other hand, experienced acupuncturists can be very helpful during pregnancy when the mother is trying to avoid taking unnecessary drugs. Be sure to tell the acupuncturist if you are pregnant or think you may be. Using acupuncture to treat morning sickness or other illness during pregnancy should be undertaken with consultation between your obstetrician and your acupuncture practitioner.

·  People on anticoagulant drugs may bleed easily even when thin acupuncture needles are inserted. Consult your physician before having acupuncture if you are on such medication.

·  Electrical stimulation of acupuncture needles could cause problems for people with pacemakers, as could magnets, which are sometimes used to stimulate acupoints.

 

·  Anyone with a compromised immune system needs to be especially careful that the acupuncturist is using disposable needles.

·  If you have multiple (and complicated) medical and pain problems, acupuncture may be harder to successfully perform or may cause changes in your reaction to your medications. In such cases, consult a medically trained physician acupuncturist or get a referral from your own doctor to an LAc the doctor has worked with. Reviewed 2004

Referrences

1.      Park J, et al. Effectiveness of acupuncture for stroke: a systematic review. J Neurol. 2001;248:558.

2.      Sze, et al. Does acupuncture improve motor recovery after stroke? A meta-analysis of randomized controlled trials. Stroke. 2002;33:2604.

3.      Ezzo J. Is acupuncture effective for the treatment of chronic pain? A systematic review. Pain. 2000;86:217.

4.      Alimi, et al. Analgesic effect of auricular acupuncture for cancer pain: A  randomized, blinded, controlled trial. J Clin Oncol. 2003;15:4120.

5.      Fink, et al. Acupuncture in chronic epicondylitis: A randomized controlled trial. Rheumatology. 2002;41:205.

6.      Irnich, et al. Randomised trial of acupuncture compared with conventional and massage and “sham” laser acupuncture for treatment of chronic neck pain. BMJ. 2001;322:1574.

7.      Carlsson, et al. Acupuncture for chronic low back pain: A randomized placebo-controlled study with long term follow up. Clin J Pain. 2001;17:296.

8.      Molsberger, et al. Does acupuncture improve the orthopedic management of chronic low back pain – A randomized, blinded, controlled trial with 3 months follow up. Pain. 2002;99:579.

9.      He D, Veiersted KB, Hostmark AT, Medbo JI. Effect of acupuncture treatment on chronic neck and shoulder pain in

sedentary female workers: a 6-month and 3-year follow-up

study. Pain. 2004 Jun;109(3):299-307.


Date Published: 09/28/2005
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