Accupuncture



by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit




The correct spelling is "acupuncture." However, many people do misspell it, particularly when they’re doing an internet search.

Information from the The National Center for Complementary and Alternative Medicine (NCAM)

Acupuncture is one of the oldest, most commonly used medical procedures in the world. Originating in China more than 2,000 years ago, acupuncture began to become better known in the United States in 1971, when New York Times reporter James Reston wrote about how doctors in China used needles to ease his pain after surgery.

The term acupuncture describes a family of procedures involving stimulation of anatomical points on the body by a variety of techniques. American practices of acupuncture incorporate medical traditions from China, Japan, Korea, and other countries. The acupuncture technique that has been most studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.

In the past two decades, acupuncture has grown in popularity in the United States. The report from a Consensus Development Conference on Acupuncture held at the National Institutes of Health (NIH) in 1997 stated that acupuncture is being "widely" practiced--by thousands of physicians, dentists, acupuncturists, and other practitioners--for relief or prevention of pain and for various other health conditions. According to the 2002 National Health Interview Survey--the largest and most comprehensive survey of complementary and alternative medicine (CAM) use by American adults to date--an estimated 8.2 million U.S. adults had ever used acupuncture, and an estimated 2.1 million U.S. adults had used acupuncture in the previous year.

Acupuncture needles are metallic, solid, and hair-thin. People experience acupuncture differently, but most feel no or minimal pain as the needles are inserted. Some people are energized by treatment, while others feel relaxed. Improper needle placement, movement of the patient, or a defect in the needle can cause soreness and pain during treatment.4 This is why it is important to seek treatment from a qualified acupuncture practitioner.The U.S. Food and Drug Administration (FDA) approved acupuncture needles for use by licensed practitioners in 1996. The FDA requires that sterile, nontoxic needles be used and that they be labeled for single use by qualified practitioners only.

Relatively few complications from the use of acupuncture have been reported to the FDA in light of the millions of people treated each year and the number of acupuncture needles used. Still, complications have resulted from inadequate sterilization of needles and from improper delivery of treatments. Practitioners should use a new set of disposable needles taken from a sealed package for each patient and should swab treatment sites with alcohol or another disinfectant before inserting needles. When not delivered properly, acupuncture can cause serious adverse effects, including infections and punctured organs.

According to the NIH Consensus Statement on Acupuncture, there have been many studies on acupuncture's potential usefulness, but results have been mixed because of complexities with study design and size, as well as difficulties with choosing and using placebos or sham acupuncture. However, promising results have emerged, showing efficacy of acupuncture, for example, in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations--such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low-back pain, carpal tunnel syndrome, and asthma--in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. An NCCAM-funded study recently showed that acupuncture provides pain relief, improves function for people with osteoarthritis of the knee, and serves as an effective complement to standard care.7 Further research is likely to uncover additional areas where acupuncture interventions will be useful.

NIH has funded a variety of research projects on acupuncture. These grants have been funded by NCCAM, its predecessor the Office of Alternative Medicine, and other NIH institutes and centers.

Acupuncture is one of the key components of the system of traditional Chinese medicine (TCM). In the TCM system of medicine, the body is seen as a delicate balance of two opposing and inseparable forces: yin and yang. Yin represents the cold, slow, or passive principle, while yang represents the hot, excited, or active principle. Among the major assumptions in TCM are that health is achieved by maintaining the body in a "balanced state" and that disease is due to an internal imbalance of yin and yang. This imbalance leads to blockage in the flow of qi (vital energy) along pathways known as meridians. It is believed that there are 12 main meridians and 8 secondary meridians and that there are more than 2,000 acupuncture points on the human body that connect with them.

Preclinical studies have documented acupuncture's effects, but they have not been able to fully explain how acupuncture works within the framework of the Western system of medicine that is commonly practiced in the United States. It is proposed that acupuncture produces its effects through regulating the nervous system, thus aiding the activity of pain-killing biochemicals such as endorphins and immune system cells at specific sites in the body. In addition, studies have shown that acupuncture may alter brain chemistry by changing the release of neurotransmitters and neurohormones and, thus, affecting the parts of the central nervous system related to sensation and involuntary body functions, such as immune reactions and processes that regulate a person's blood pressure, blood flow, and body temperature.

Health care practitioners can be a resource for referral to acupuncturists. More medical doctors, including neurologists, anesthesiologists, and specialists in physical medicine, are becoming trained in acupuncture, TCM, and other CAM therapies. In addition, national acupuncture organizations (which can be found through libraries or Web search engines) may provide referrals to acupuncturists.

Check a practitioner's credentials.
An acupuncture practitioner who is licensed and credentialed may provide better care than one who is not. About 40 states have established training standards for acupuncture certification, but states have varied requirements for obtaining a license to practice acupuncture. Although proper credentials do not ensure competency, they do indicate that the practitioner has met certain standards to treat patients through the use of acupuncture.

Do not rely on a diagnosis of disease by an acupuncture practitioner who does not have substantial conventional medical training.

If you have received a diagnosis from a doctor, you may wish to ask your doctor whether acupuncture might help.

A practitioner should inform you about the estimated number of treatments needed and how much each will cost. If this information is not provided, ask for it. Treatment may take place over a few days or for several weeks or more. Physician acupuncturists may charge more than non-physician practitioners.

Acupuncture is one of the CAM therapies that are more commonly covered by insurance. However, you should check with your insurer before you start treatment to see whether acupuncture will be covered for your condition and, if so, to what extent. Some insurance plans require pre-authorization for acupuncture.

During your first office visit, the practitioner may ask you at length about your health condition, lifestyle, and behavior. The practitioner will want to obtain a complete picture of your treatment needs and behaviors that may contribute to your condition. Inform the acupuncturist about all treatments or medications you are taking and all medical conditions you have.

To determine the effectiveness of acupuncture, two recent clinical trials were conducted and published in the Annals of Internal Medicine.



Effectiveness of Acupuncture as Adjunctive Therapy in Osteoarthritis of the Knee
A Randomized, Controlled Trial
Brian M. Berman, MD; Lixing Lao, PhD; Patricia Langenberg, PhD; Wen Lin Lee, PhD; Adele M.K. Gilpin, PhD; and Marc C. Hochberg, MD

21 December 2004 | Volume 141 Issue 12 | Pages 901-910


Background: Evidence on the efficacy of acupuncture for reducing the pain and dysfunction of osteoarthritis is equivocal.

Objective: To determine whether acupuncture provides greater pain relief and improved function compared with sham acupuncture or education in patients with osteoarthritis of the knee.

Design: Randomized, controlled trial.

Setting: Two outpatient clinics (an integrative medicine facility and a rheumatology facility) located in academic teaching hospitals and 1 clinical trials facility.

Patients: 570 patients with osteoarthritis of the knee (mean age [±SD], 65.5 ± 8.4 years).

Intervention: 23 true acupuncture sessions over 26 weeks. Controls received 6 two-hour sessions over 12 weeks or 23 sham acupuncture sessions over 26 weeks.

Measurements: Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at 8 and 26 weeks. Secondary outcomes were patient global assessment, 6-minute walk distance, and physical health scores of the 36-Item Short-Form Health Survey (SF-36).

Results: Participants in the true acupuncture group experienced greater improvement in WOMAC function scores than the sham acupuncture group at 8 weeks (mean difference, –2.9 [95% CI, –5.0 to –0.8]; P = 0.01) but not in WOMAC pain score (mean difference, –0.5 [CI, –1.2 to 0.2]; P = 0.18) or the patient global assessment (mean difference, 0.16 [CI, –0.02 to 0.34]; P > 0.2). At 26 weeks, the true acupuncture group experienced significantly greater improvement than the sham group in the WOMAC function score (mean difference, –2.5 [CI, –4.7 to –0.4]; P = 0.01), WOMAC pain score (mean difference, –0.87 [CI, –1.58 to –0.16];P = 0.003), and patient global assessment (mean difference, 0.26 [CI, 0.07 to 0.45]; P = 0.02).

Limitations: At 26 weeks, 43% of the participants in the education group and 25% in each of the true and sham acupuncture groups were not available for analysis.

Conclusions: Acupuncture seems to provide improvement in function and pain relief as an adjunctive therapy for osteoarthritis of the knee when compared with credible sham acupuncture and education control groups.



Acupuncture versus Placebo for the Treatment of Chronic Mechanical Neck Pain
A Randomized, Controlled Trial
Peter White, PhD, BSc; George Lewith, DM, FRCP; Phil Prescott, PhD, DIC, ARCS, BSc; and Joy Conway, PhD

21 December 2004 | Volume 141 Issue 12 | Pages 911-919


Background: Despite substantial increases in its popularity and use, the efficacy of acupuncture for chronic mechanical neck pain remains unproved.

Objective: To compare acupuncture and placebo for neck pain.

Design: A randomized, single-blind, placebo-controlled, parallel-arm trial with 1-year follow-up.

Setting: The outpatient departments of 2 major hospitals in the United Kingdom, 1999 to 2001.

Patients: 135 patients 18 to 80 years of age who had chronic mechanical neck pain. Eleven patients withdrew from treatment, and 124 completed the primary end point.

Measurements: The primary outcome was pain 1 week after treatment, according to a visual analogue scale. Secondary outcomes were pain at other time points, score on the Neck Disability Index and the Short Form-36, and use of analgesic medications.

Interventions: Patients were randomly assigned to receive, over 4 weeks, 8 treatments with acupuncture or with mock transcutaneous electrical stimulation of acupuncture points using a decommissioned electroacupuncture stimulation unit.

Results: Both groups improved statistically from baseline, and acupuncture and placebo had similar credibility. For the primary outcome (weeks 1 to 5), a statistically significant difference in visual analogue scale score in favor of acupuncture (6.3 mm [95% CI, 1.4 to 11.3 mm]; P = 0.01) was observed between the 2 study groups, after adjustment for baseline pain and other covariates. However, this difference was not clinically significant because it demonstrated only a 12% (CI, 3% to 21%) difference between acupuncture and placebo. Secondary outcomes showed a similar pattern.

Limitations: All treatments were provided by 1 practitioner. Although the control was credible, it did not mimic the process of needling. A nonintervention group was not present to control for regression to the mean.

Conclusions: Acupuncture reduced neck pain and produced a statistically, but not clinically, significant effect compared with placebo. The beneficial effects of acupuncture for pain may be due to both nonspecific and specific effects.



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