It is quite common these days to hear about people turning to acupuncture as a last resort for relief from chronic health problems. The popularity of alternative therapies such as acupuncture is variable among developed countries, but public demand is strong and growing. In recent surveys published in the Journal of American Medical Association (1998), the percentage of the public reporting use of at least one alternative therapy in the U.S. increased from 38 % in 1990 to 42 % in 1997. Estimates available from Europe show the corresponding percentage to be much higher, particularly for acupuncture and homeopathy (British Medical Journal, 1994). A few years ago, the Food and Drug Administration estimated that 9 to 12 million acupuncture treatments were being performed annually, and this estimate is surely much higher now.
What is Acupuncture?
Acupuncture was developed by the Chinese and has been in use for more than 3000 years. The practice is part of a larger integrated system, the Traditional Chinese Medicine (TCM) system. Simply put, acupuncture is performed by stimulating designated points on the body—through the insertion of needles, finger pressure, the application of heat, or a combination of all these treatments.
Network of energy
According to the Chinese, there is a network of energy (called chi or qi) that flows through the body and connects acupuncture points through different channels called meridians. These channels are related to specific internal functions, and any imbalance in the flow of energy will cause a disease process. Therefore, the purpose of TCM and acupuncture assessments is to detect energy imbalance. Acupuncture assessments are made according to diagnostic categories of energy (qi) flow, as measured by a complete medical history—examination of pulse, tongue, and other organs, as well as other observations. Any imbalance of energy detected through these comprehensive assessments is then corrected by application of acupuncture at carefully selected points. This restores the human body to normal health.
In its first encounters with acupuncture, Western medicine was understandably suspicious, since explanations of exactly how the procedure works are bound up in seemingly mysterious concepts formulated 3000 years ago. However, in light of recent advancements in understanding the neurophysiology of pain—and scientific explanations of how acupuncture relieves it—suspicion is giving way to tolerance and acceptance.
Acupuncture and Scientific Research Studies
Findings emerging from both basic science and epidemiological research have been encouraging, since many studies have shown the potential usefulness of acupuncture. Some studies, however, have provided equivocal results because of methodological problems in conducting acupuncture research.
To address important research issues, the National Institutes of Health (NIH) Office of Alternative Medicine organized a 2 ½ week conference on acupuncture that took place in November of 1997. The panel concluded that research shows promising results in favor of acupuncture in both the treatment of nausea associated with chemotherapy and post-operative situations, as well as with post-operative dental pain. The panel also pointed to sufficient evidence that acupuncture may be a useful adjunct in the treatment of a variety of other conditions.
The way acupuncture works neurologically is also rapidly becoming apparent, speeding up its acceptance into traditional medicine. Needles used in acupuncture activate small nerve fibers in the muscle, which transmit impulses to the spinal cord and activate centers in the central nervous system, releasing a variety of neurotransmitters. Pain relief, for example, is mediated by the release of opioid-like substances. Although much still needs to be learned, the emergence of biological plausibility for the therapeutic effects of acupuncture is certainly encouraging.
While skeptics argue that acupuncture mediated response might be due to placebo, several reviews have concluded that it is more effective than placebo, indicating that it has a genuine physical effect.
In 1996, after careful review of acupuncture knowledge and research, the Food and Drug Administration (FDA) removed acupuncture needles from the category of "experimental medical devices." This means that acupuncture is no longer considered to be experimental in nature.
Who Chooses Acupuncture?
In my practice, I see patients who suffer from chronic painful debilitating medical problems. Many view the conventional health care system with skepticism and wonder why they could not be helped. Eventually, they turn to acupuncture to find relief from pain and other troublesome symptoms.
Supporters of acupuncture claim that this remedy is more accessible, and less expensive, than conventional medicine. Also, the effectiveness of conventional treatments is limited in treating chronic health problems. Chronic pain is a case in point. For example, treatment of pain associated with osteoarthritis and fibromyalgia with non-steroidal anti-inflammatory drugs (NSAIDS) is seldom beneficial. Additionally, patients are concerned about side effects associated with surgery and conventional medications. An article in the Journal of the American Medical Association (1998) estimates there are 100,000 deaths each year in U.S. hospitals caused by pharmaceutical drugs.
Who Benefits From Acupuncture?
Patients who seek acupuncture are mainly those who suffer from long-standing chronic problems such as back and neck pain, headaches and migraines, arthritis, cancer, neurological disorders, anxiety, and depression. These problems strike women more than men, which could certainly explain why currently more women are using acupuncture than men.
Conventional healthcare providers are beginning to view acupuncture as an effective complementary modality to conventional care, and its use is being recommended more and more. Acupunture is also gaining a reputation for efficacy, and as an attractive drug- and surgery-free option for many patients. An extensive review of studies has shown that acupuncture is effective for the following conditions:
- Pain. Examples of pain producing conditions that respond favorably to acupuncture include arthritis, myofascial pain syndrome, dental pain, neck and low back pain, carpal tunnel syndrome, and fibromyalgia.
- Headache and migraines.
- Nausea associated with chemotherapy.
- Substance abuse problems, such as those related to cocaine, heroine and nicotine.
- Menopause and PMS related symptoms.
- Asthma and allergies.
Further research is likely to reveal additional areas where acupuncture interventions will become useful.
How is Acupuncture Performed?
Acupuncture is done with extremely thin, flexible needles made of steel metal alloy. There is nothing special about the needle itself; it is merely a tool used to correct the energy imbalance in the body (or to release neurotransmitters). There is often a brief pricking sensation when the needle passes through the skin. As the needle begins to work and effects begin to occur, the patient may feel numbness, heat, dull aching or a tingling sensation in the vicinity of the needle insertion. Generally, the needles are left in place for about 15 to 30 minutes. They may be rotated by the practitioner or stimulated by electricity or heat. Most side effects associated with acupuncture are minor and transient. They include occasional dizziness, light-headedness, and very slight bleeding after needles are withdrawn. Infection and other serious side effects such as lung puncture are rare. Patients should always insist that the acupuncturist use sterile and disposable needles to avoid the risk of infectious diseases such as Hepatitis B and AIDS.
Some Practical Matters
It is reported that several thousand Americans receive acupuncture treatments each year. Access to qualified practitioners is of paramount importance. The health care systems should facilitate and allow for effective communication between acupuncturists and conventional health care providers, since integrating acupuncture with conventional care will better serve the interests of our patients.
Finding an acupuncturist in your area
Most states allow the practice of acupuncture. To locate a physician acupuncturist, call your local medical society or hospital based pain or complementary medicine service. You may also call the American Academy of Medical Acupuncture (1-800-521-2262) to obtain names of physicians who practice acupuncture in your area.
Lay acupuncturists, who are non-MDs, should have a state license and be certified by the National Commission for the Certification of Acupuncturists, which requires acupuncturists to pass an examination after a suitable period of training.
Many patients have limited access to acupuncture care because they are unable to pay. At the present time, populations served by Medicare and Medicaid are not eligible for acupuncture care. An increasing number of employers and insurance companies are considering the possibility of coverage for acupuncture services. If you are unsure about your coverage, call your insurance company to get information specific to your situation.
Integrating conventional and acupuncture methods of care
Before seeking acupuncture treatments for your health problem, you should undergo a thorough conventional evaluation by your own physician. Have the acupuncturist explain acupuncture in detail and be sure your doctor and acupuncturist communicate with each other.
Acupuncture shows promise as one of the many healthcare options available to patients. Its role as an adjunct in the management of a select number of conditions, particularly chronic pain, should be explored. Its use should be given serious consideration, particularly by persons who are concerned about the efficacy and side effects of surgery or medications for pain relief.
While it is not being suggested that acupuncture provides a cure for all problems, there is sufficient evidence that, if appropriately used, this discipline of medicine can successfully complement conventional treatments so as to provide patients with the best healthcare available.