Acupuncture

Written by PainDoctor.com Staff | 28 July 2010

Acupuncture has been used to prevent and treat diseases for more than 3,000 years¹. When practiced by a certified provider, acupuncture is safe, and patients often find it calming and relaxing².

Acupuncture involves the insertion of needles into acupuncture points located on the surface of the body. These points are situated along pathways called meridians. Meridians are believed to be associated with certain organs and other anatomic landmarks. During a typical treatment session, several needles are placed in multiple acupuncture points and the needles are sometimes moved gently or stimulated with electricity (electroacupuncture) to enhance their effect.

One of the primary treatment goals of acupuncture is pain relief (analgesia). According to a consensus statement released by the National Institutes of Health (NIH), acupuncture is thought to work in concert with the body’s natural pain reduction system by eliciting the release of endorphins, stimulating the peripheral nervous system and mediating pain through neuropeptides³. This idea is backed by human and animal studies that suggest acupuncture elicits analgesia through the physiologic effect of needling upon the complex central and peripheral neuro-hormonal network within the body⁴.

There is controversy as to whether or not acupuncture is more effective than placebo. However, research continues to explore the use of acupuncture in the treatment of many chronic pain conditions, and accumulating evidence from recent reviews suggests that acupuncture is significantly more effective than placebo for commonly occurring chronic pain conditions⁵. In fact, acupuncture care has been shown to produce clinically relevant short- and long-term benefits in a variety of health conditions⁶.

Common conditions successfully treated by acupuncture include:

• Osteoarthritis (OA) — A controlled study in 121 patients with knee osteoarthritis found patients in the treatment group who received electroacupuncture plus manipulative regulation of knee muscle balance experienced greater reduction in pain, joint stiffness and joint swelling than patients in the control group who were treated with oral Diclofenac Sodium tablets. The researchers concluded acupuncture plus manipulative regulation of knee muscle balance can effectively improve the clinical symptoms and knee motor function of patients with knee osteoarthritis, and can inhibit further development of disease. Another clinical trial reported acupuncture effectively treated hip osteoarthritis, relieved joint pain, and improved joint function, and the researchers declared the efficacy of acupuncture to be superior to that of Diclofenac Sodium therapy.
• Low Back Pain — There is moderate evidence that acupuncture is effective for chronic low back pain⁷. A randomized, controlled study of 60 cases of lower back myofascitis found penetration needling in a specific meridian of the back combined with electroacupuncture was superior to administration of oral Ibuprofen capsules in the reduction of pain and improvement of function among test subjects⁸. And a study comparing the effectiveness of acupuncture and local anesthetic injections at the most painful points in patients with low back pain found both injection and acupuncture relieved pain, but acupuncture was superior for immediate and sustained effects⁹. The researchers concluded the difference in the observed effects may have been attributable to differences in the mechanism of pain suppression between the two treatments.
• Headaches — According to a Cochrane Systematic Review, acupuncture has in certain studies been associated with slightly better outcomes and fewer adverse events than prophylactic drug treatments in headache patients¹⁰. Another review, which examined the efficacy of acupuncture as a treatment for tension-type headache, found small but statistically significant benefits of acupuncture over sham for pain as well as several other outcomes¹¹. A specific type of headache treated by acupuncture is migraine. Acupuncture is thought to treat migraine by inhibiting neurogenic inflammation, improving cerebro-microcirculation, and regulating vasoactive substances¹². A randomized, controlled trial in 253 cases of migraine divided patients into acupuncture and Western medicine groups and found mean times and duration of headache attacks were significantly improved in the two groups but more so in the acupuncture group¹³. In addition, one year later, compliance was greater and the incidence of adverse events lower in the acupuncture group than in the Western medicine group.
• Neck/Facial Pain — Patients presenting with oromyofacial disorders and pain in the head and neck area are often resistant to conventional therapy, and acupuncture may bring immediate pain relief to these individuals¹⁴. A single-blind, randomized controlled trial in 35 patients randomly allocated to acupuncture or sham acupuncture groups found the acupuncture group had greater gains in quality of life as assessed with Short Form-36, as well as better neck range of motion and reduced motion-related pain, as determined by a blinded investigator¹⁵. And a study in 23 patients with craniomandibular disorders, headache and, in particular, local pain in the orofacial, cervical and temporomandibular joint areas found the sum of pain scores across 14 muscles was considerably more reduced after acupuncture as compared to a sham laser treatment¹⁶.
• Fibromyalgia — Patients with fibromyalgia are reported to benefit from acupuncture, according to the results of various randomized, controlled clinical trials^17,18. A systematic review of 25 such trials including 1,516 patients discovered acupuncture reduced the number of tender points and pain scores compared with treatment with conventional medications¹⁹.
• Postoperative Pain — There are numerous trials reporting that acupuncture lowers postoperative pain. A randomized, placebo-controlled study in patients with abdominal postoperative pain showed those who received acupuncture had markedly better pain relief than those who received intramuscular injections of Bucinnazine²⁰. In addition, studies in electroacupuncture have found the treatment improved acute postoperative pain management without adversely affecting vital signs in patients who received surgery for non-traumatic spinal cord injury²¹, and decreased pain and limited opioid and non-opioid medication intake during the first 7 postoperative days in patients who received coronary bypass procedures²². Similarly beneficial results have been observed in patients undergoing neck dissection²³ and surgery for hemorrhoids²⁴.
• Nausea — In the case of nausea, an updated Cochrane Review published in 2009 concluded that penetrative or non-penetrative stimulation of the P6 acupuncture point was approximately equal to preventive antiemetic drugs for postoperative nausea and vomiting²⁵. Another Cochrane Review concluded that electroacupuncture can be helpful in the treatment of vomiting after the start of chemotherapy, but more trials were needed to test the effectiveness of the treatment versus modern anti-vomiting medications²⁶.
• Menstrual Cramps (Dysmenorrhea) — Acupuncture has been shown to bring pain relief to patients with menstrual cramps. A clinical trial in 63 patients with moderate primary dysmmenorrhea found either single-point or multi-point acupuncture at Shiqizhui (EX-B 8) and other acupoints had apparent immediate analgesia in these patients²⁷. And a randomized, controlled clinical trial in 73 cases of dysmenorrhea caused by endometriosis found acupuncture significantly lowered pain in these individuals²⁸.

Procedure

In the United States, two types of practitioners practice acupuncture. These include Medical Doctors (MDs), who often offer acupuncture as adjunctive therapy to their patients, and Alternative Providers. Most states require that Medical Doctors have 200 to 300 hours of acupuncture training in addition to their medical training. Alternative Providers typically complete 2,000 to 3,000 hours of training and must pass board examinations conducted by a national acupuncture accreditation agency.

Generally, the acupuncturist will obtain a thorough history, perform a targeted physical exam, form a diagnosis and discuss the expected outcome of treatment. Sterilized, fine stainless steel needles are used during treatment. A brief, sharp sensation may be experienced when the needle is first inserted, but significant pain is not typically experienced during needling. Any discomfort produced by insertion of the needles is typically minimal due to the fine caliber of the needles used. The needles usually stay in place for fifteen to thirty minutes and a typical session lasts about an hour. Following treatment, the patient is able to return to normal daily activities.

Side effects of acupuncture may include heaviness, numbness, or tingling after the needles have been inserted. Most practitioners recommend several treatments to determine whether acupuncture is effective in a patient.

Benefits

Acupuncture has been demonstrated to be a successful alternative treatment for many different painful conditions. It is believed that acupuncture may produce some of its beneficial effects by stimulating spinal nerves to release endorphins, or pain-suppressing neurotransmitters. Endorphins have been shown to have an effect similar to taking a pain medication.

In addition to pain relief, acupuncture may produce beneficial effects upon blood pressure, blood flow and body temperature, which are regulated by the central nervous system. Insertion of needles seems to increase the blood flow in the area surrounding the needle. The increase in blood flow supplies nourishment to tissues and removes toxic substances.

Another significant benefit of acupuncture is that it is a non-pharmacologic way to reduce pain. Although many patients may experience pain relief through drugs, overuse and dependence can limit the effectiveness of pharmacologic therapies. For example, patients who take opioid medications for chronic pain conditions are at risk for tolerance, dependence and harmful side effects. Acupuncture may be beneficial in patients who wish to avoid taking drugs to relieve pain and other symptoms.

Risks

There is general agreement that acupuncture is safe when administered by well-trained practitioners using sterile needles^29,30. However, as with medical interventions, acupuncture treatments can produce complications in rare cases. However, the risks associated with acupuncture are generally minor as the procedure is minimally invasive. Common side effects may include superficial bleeding or bruising at the needle sites.

A 2011 study of 1,968 patients found 74 patients (3.76%) experienced adverse events throughout the treatment, including subcutaneous hematoma, bleeding, skin bruising and needle site pain³¹. The researchers noted that older age was associated with a higher risk of experiencing adverse events.

Acupuncture has re-emerged in contemporary Western Medicine as an effective treatment option for many different pain conditions. Although acupuncture should not be considered first-line treatment for many serious conditions including cancer, diabetes, and infection, it has proven to be immensely valuable in treating several diseases and pain conditions, especially in disorders involving chronic pain.

References

1. Schiapparelli P, Allais G, Castagnoli Gabellari I, Rolando S, Terzi MG, & Benedetto C. (2010). Non-pharmacological approach to migraine prophylaxis: part II. Neurol Sci., 31 Suppl 1, S137-9.
2. Mao JJ, & Kapur R. (2010). Acupuncture in primary care. Prim Care., 37(1), 105-17.
3. NIH Consensus Development Program (November 3–5, 1997). "Acupuncture --Consensus Development Conference Statement". National Institutes of Health. consensus.nih.gov/1997/1997Acupuncture. Retrieved 2007-07-17.
4. Mao JJ, & Kapur R. (2010). Acupuncture in primary care. Prim Care., 37(1), 105-17.
5. Hopton A, & MacPherson H. (2010). Acupuncture for chronic pain: is acupuncture more than an effective placebo? A systematic review of pooled data from meta-analyses. Pain Pract., 10(2), 94-102.
6. Mao JJ, & Kapur R. (2010). Acupuncture in primary care. Prim Care., 37(1), 105-17.
7. Furlan AD, van Tulder MW, Cherkin DC, Tsukayama H, Lao L, Koes BW, & Berman BM. (2005). Acupuncture and dry-needling for low back pain. Cochrane Database Syst Rev., (1), CD001351.
8. Sun YZ, & Li DY. [Observation on lower back myofascitis treated with penetration needling on yang meridians of the back and electroacupuncture as compared with Western medication]. [Article in Chinese]. Zhongguo Zhen Jiu., 30(10), 816-8.
9. Inoue M, Hojo T, Nakajima M, Kitakoji H, & Itoi M. (2009). Comparison of the effectiveness of acupuncture treatment and local anaesthetic injection for low back pain: a randomised controlled clinical trial. Acupunct Med., 27(4), 174-7.
10. Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, & White A. (2009). Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev., (1), CD001218.
11. Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, & White AR. (2009). Acupuncture for tension-type headache. Cochrane Database Syst Rev., (1), CD007587.
12. Deng ZQ, Zhao L, & Li Y. (2010). [Progress of experimental studies on the underlying mechanism of acupuncture treatment of migraine].[Article in Chinese]. Zhen Ci Yan Jiu., 35(4), 315-8.
13. Zhong GW, Li W, Luo YH, Wang SE, Wu QM, Zhou B, Chen JJ, & Liu BL. (2009). [Acupuncture at points of the liver and gallbladder meridians for treatment of migraine: a multi-center randomized and controlled study]. [Article in Chinese]. Zhongguo Zhen Jiu., 29(4), 259-63.
14. Simma I, Gleditsch JM, Simma L, & Piehslinger E. (2009). Immediate effects of microsystem acupuncture in patients with oromyofacial pain and craniomandibular disorders (CMD): a double-blind, placebo-controlled trial. Br Dent J., 207(12), E26.
15. Sun MY, Hsieh CL, Cheng YY, Hung HC, Li TC, Yen SM, & Huang IS. (2010). The therapeutic effects of acupuncture on patients with chronic neck myofascial pain syndrome: a single-blind randomized controlled trial. Am J Chin Med. , 38(5), 849-59.
16. Simma I, Gleditsch JM, Simma L, & Piehslinger E. (2009). Immediate effects of microsystem acupuncture in patients with oromyofacial pain and craniomandibular disorders (CMD): a double-blind, placebo-controlled trial. Br Dent J., 207(12), E26.
17. Martin DP, Sletten CD, Williams BA, & Berger IH. (2006). Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial. Mayo Clin Proc., 81(6), 749-57.
18. Targino RA, Imamura M, Kaziyama HH, Souza LP, Hsing WT, Furlan AD, Imamura ST, & Azevedo Neto RS. (2008). A randomized controlled trial of acupuncture added to usual treatment for fibromyalgia. J Rehabil Med., 40(7), 582-8.
19. Cao H, Liu J, & Lewith GT. (2010). Traditional Chinese Medicine for treatment of fibromyalgia: a systematic review of randomized controlled trials. J Altern Complement Med., 16(4), 397-409.
20. Xu YH, Wang QY, Yu ZB, & He YW. (2010). Zhongguo Zhen Jiu., 30(11), 904-6.
21. Yeh ML, Chung YC, Chen KM, Tsou MY, & Chen HH. (2010). Acupoint electrical stimulation reduces acute postoperative pain in surgical patients with patient-controlled analgesia: a randomized controlled study. Altern Ther Health Med., 16(6), 10-8.
22. Colak MC, Kavakli A, Kilinç A, & Rahman A. (2010). Postoperative pain and respiratory function in patients treated with electroacupuncture following coronary surgery. Neurosciences (Riyadh)., 15(1), 7-10.
23. Pfister DG, Cassileth BR, Deng GE, Yeung KS, Lee JS, Garrity D, Cronin A, Lee N, Kraus D, Shaha AR, Shah J, & Vickers AJ. (2010). Acupuncture for pain and dysfunction after neck dissection: results of a randomized controlled trial. J Clin Oncol., 28(15), 2565-70.
24. Xu TS, & Qian HH. (2009). [Clinical observation on the effect of acupuncture-assisted anesthesia for 40 cases of mixed hemorrhoids surgery]. [Article in Chinese]. Zhen Ci Yan Jiu., 34(6), 403-5.
25. Lee A, & Fan, L. (2009). Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting. Cochrane Database of Systematic Reviews., (2), CD003281.
26. Ezzo JM, Richardson, MA, Vickers A, Allen C, Dibble SL, Issell BF, Lao, L, & Pearl M. (2006). Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. Cochrane Database of Systematic Reviews., (2), CD002285.
27. Chen SZ, Cong Q, & Zhang BF. (2011). [Preliminary comparison on the time-effect rule of pain-relieving in the treatment of moderate dysmenorrhea between acupuncture on single-point and acupuncture on multi-point].[Article in Chinese]., Zhongguo Zhen Jiu., 31(4):, 305-8.
28. Chen M, Zhang H, Li J, & Dong GR. (2010). [Clinical observation on acupuncture combined with acupoint sticking therapy for treatment of dysmenorrhea caused by endometriosis]. [Article in Chinese]. Zhongguo Zhen Jiu., 30(9), 725-8.
29. "Acupuncture Consensus Development Conference Statement November 3-5, 1997 National Institutes of Health." NIH Consensus Development Program. National Institutes of Health, November 1997. Web. 13 Jul 2011. consensus.nih.gov/1997/1997Acupuncture.
30. "Acupuncture ." National Center for Complementary and Alternative Medicine. National Institutes of Health, National Center for Complementary and Alternative Medicine, April 01, 2011 . Web. 12 Jul 2011. nccam.nih.gov/health/acupuncture.
31. Zhao L, Zhang FW, Li Y, Wu X, Zheng H, Cheng LH, & Liang FR. (2011). Adverse events associated with acupuncture: three multicentre randomized controlled trials of 1968 cases in China. Trials., 12, 87.