What Is Acupuncture?

Acupuncture is a form of complementary and alternative medicine (CAM) used to relieve acute and chronic pain (Berman et al, 2012). It is also part of a system of medical theory and practice known as Traditional Chinese Medicine (Berman et al, 2012). Practiced since antiquity, acupuncture has been used to prevent and treat diseases for more than 3,000 years (Schiapparelli et al, 2010).

In Traditional Chinese Medicine, health is governed by harmony or disharmony amongst body systems and between the body and nature. Disharmony is thought to obstruct the body’s vital energy, qi, which runs along a system of pathways termed meridians. According to a review, the existence of meridians is backed by data from studies employing biophysics, biochemistry, and molecular biology, which suggested meridians may have electric, acoustic, thermal, optical, magnetic, isotopic, and myoelectric properties (Li et al, 2012).

Acupuncture Therapy - Alternative MedicineAcupuncture involves the insertion of fine, solid, metallic needles into points in the skin situated along meridians. There are 12 primary meridians linked to specific internal organs such as the heart, and eight secondary meridians considered to be vessels or reservoirs of Qi (Berman et al, 2010). Sometimes the needles may be manipulated with the hands, heat, or electrical stimulation (electroacupuncture).

A variety of theories endeavor to explain how acupuncture produces analgesia, or pain relief. According to an early consensus statement released by the National Institutes of Health (NIH), acupuncture is thought to work in concert with the body’s natural pain relief mechanisms by causing release of endorphins and hormones that lower inflammation (1997). These physiological responses may be caused by the physiological effect of needling upon the body’s neuro-hormonal network (Chou et al, 2012; Mao & Kapur, 2010). Acupuncture may also produce benefits in the tissues surrounding the needles by mechanically stimulating connective tissues and increasing blood flow (Berman et al, 2012).

In the United States, two types of practitioners administer acupuncture. These include medical doctors (MDs) who offer acupuncture as adjunctive therapy to their patients, and alternative providers certified by the National Certification Commission for Acupuncture and Oriental Medicine. Most states require that MDs complete 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.

Procedure

In a typical acupuncture consultation, the acupuncturist will first take the patient’s history. He or she will then perform a physical examination, assessing the patient for congestion of qi, and devise a treatment plan based upon the findings. Then, with the goal of restoring the flow of qi, the practitioner inserts acupuncture needles at chosen points along particular meridians (Berman et al, 2012). Specific insertion points are used to treat particular ailments, such as chronic low back pain.

The needles used in acupuncture are composed of sterilized stainless steel. The patient may feel a mild sharp sensation upon needle insertion. Significant pain is unlikely since the caliber of the needles is so fine. In many cases, the practitioner may stimulate the needles manually, with heat, or with electrical current (electroacupuncture). Needles may also be tipped with burning mugwort, or Artesmisia vulgaris (an herb), in a procedure called “moxibustion,” which is thought to promote movement of stagnant blood and qi. The needles remain in the skin for 15 to 30 minutes.

Following treatment, the patient is able to return to customary daily activities. Acupuncturists typically recommend a course of multiple treatments to determine efficacy in a patient.

Benefits

In many cases, acupuncture is an effective therapy that provides immediate and long-term benefits in a broad assortment of conditions. Considered a relatively low-risk therapy, acupuncture has been associated with lower rates of adverse effects and complications than taking medications and undergoing more invasive procedures, and patients often find it calming and relaxing (Mao & Kapur, 2010). In addition, in many cases acupuncture serves as a valuable part of a multidisciplinary treatment plan, or a treatment regimen that includes several different treatment approaches.

OsteoarthritisA 2012 meta-analysis conducted by researchers from the Acupuncture Trialists’ Collaboration, assessed individual patient data from 29 high-quality randomized controlled trials involving a total of 17,922 people, and reported the effects of acupuncture, as experienced by patients in clinical practice, are clinically relevant (Vickers et al). The trials investigated the use of acupuncture versus sham treatments for conditions such as back and neck pain, osteoarthritis, shoulder pain, and chronic headache. The authors also noted the findings of their meta-analysis provide the strongest evidence to date that acupuncture is a viable treatment option for patients with chronic pain.

Some of the painful conditions treated with acupuncture include:

• Low back pain: There is moderate evidence that acupuncture is effective for chronic low back pain (Furlan et al, 2005). 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 subjects (Sun & Li, 2010). 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 effects (Inoue et al, 2009).

• Knee osteoarthritis (OA): A study in knee OA patients between the ages of 35 to 82 who received varieties of acupuncture found high percentages of patients experienced pain relief and improvement in knee flexibility (Karner et al, 2013). Also, researchers who conducted a study in knee OA patients who received conventional acupuncture for four weeks and were assessed after an additional four weeks reported the recipients experienced improvements in pain and knee joint mobility (Dai et al, 2012).

• Headaches: A randomized controlled trial in 66 consecutive chronic migraine patients who were treated with acupuncture or the drug topiramate over a 12-week period found a number of patients in the acupuncture group experienced reductions in moderate to severe headache days (Yang et al, 2013). These effects were particularly frequent in patients with throbbing migraines.

In addition, a Japanese study reported use of the acupuncture point BL10 (Tianzhu) produced pain relief in 47% of patients with tension-type headache, 38% of those with migraine, 50% of those with chronic daily headache, and 71% of those with neck and/or shoulder pain.

And 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 and neck range of motion, as well as reduced pain (Sun et al, 2010).

• Myofascial pain syndrome: The pain of myofascial pain syndrome, a regional pain syndrome characterized by muscle pain caused by myofascial trigger points, can be relieved immediately with needling therapies including acupuncture, according to Chou et al (2012).

Fibromyalgia Points• Fibromyalgia: A systematic review of 25 clinical trials including 1,516 patients discovered acupuncture reduced the number of tender points and pain scores compared with treatment with conventional medications (Cao et al, 2010).

Also, a randomized trial in which patients received acupuncture or the drug fluoxetine found the acupuncture group was significantly better than the fluoxetine group in the number of tender points after four weeks. In addition, total fibromyalgia symptoms were significantly improved in the acupuncture group versus the fluoxetine group during the same period (Hadianfard & Hosseinzadeh Parizi, 2012).

• Postoperative pain: A randomized placebo-controlled study in patients with postoperative abdominal pain showed those who received acupuncture experienced significantly better pain relief than those given intramuscular injections of the drug Bucinnazine (Xu et al, 2010). Additionally, electroacupuncture was shown to decrease pain as well as intake of opioids and other medications during the first seven postoperative days in patients who underwent coronary bypasses (Colak et al, 2010). Similar favorable outcomes have been observed in patients following neck and hemorrhoid surgeries (Pfister et al, 2010, Xu et al, 2009).

• Cancer pain: Guidelines issued by the National Comprehensive Cancer Network recommend acupuncture for adult cancer pain in conjunction with taking medications as needed (Lu & Rosenthal, 2013).

• Menstrual cramps (Dysmenorrhea): Studies show acupuncture may relieve menstrual cramps. For example, single-point or multi-point acupuncture at the point called Shiqizhui (EX-B 8) and other acupoints produced immediate analgesia in these patients 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 patients (Garcia et al, 2013).

Risks

When practiced by a trained provider, acupuncture is considered to be minimally risky (Mao & Kapur, 2010). However, as with any medical intervention, acupuncture treatments can produce side effects and even complications. Side effects of acupuncture include numbness and tingling following needle insertion, and reported complications have included bleeding, nausea, skin bruising, needle site pain, and one case of pneumothorax (Ding et al, 2013; Zhao et al, 2011).

Contraindications to acupuncture include bleeding and clotting and bleeding disorders such as hemophilia; use of blood thinners such as warfarin; serious psychiatric conditions such as psychosis; and breaks, burns, and infections in the skin. Electroacupuncture should not be performed near implanted electrical devices such as nerve stimulators and pacemakers.

Abdominal acupuncture is not recommended in pregnant women.

Outcomes

Acupuncture has become a contemporary, effective treatment option for many painful conditions, especially in disorders involving chronic pain. Many pain specialists incorporate acupuncture into a multidisciplinary treatment plan in the management of pain.

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Journal Articles

  1. Berman BM, Langevin HM, Witt CM, & Dubner R. (2010). Acupuncture for chronic low back pain. N Engl J Med. 363(5):454-61.
  2. 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.
  3. Chou LW, Kao MJ, & Lin JG. (2012). Probable mechanisms of needling therapies for myofascial pain control. Evid Based Complement Alternat Med. 2012:705327.
  4. 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.
  5. Dai Z, Liu Q, Bai W, Liu HS, Yang JY, & Wang SJ. (2012).
[Efficacy observation of knee osteoarthritis treated with acupuncture]. [Article in Chinese]. Zhongguo Zhen Jiu. 32(9):785-8.
  • Ding M, Qiu Y, Jiang Z, Tang L, & Jin C. (2013). Acupuncture-Associated Pneumothorax. J Altern Complement Med. 2013 Jan 14. [Epub ahead of print]
  • 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.
  • Garcia MK, McQuade J, Haddad R, Patel S, Lee R, Yang P, Palmer JL, Cohen L. (2013). Systematic review of acupuncture in cancer care: a synthesis of the evidence. J Clin Oncol. 31(7):952-60.
  • Hadianfard MJ, Hosseinzadeh Parizi M. (2012). A randomized clinical trial of fibromyalgia treatment with acupuncture compared with fluoxetine. Iran Red Crescent Med J. 14(10):631-40.
  • Huang GF, Zhang HX, Xu ZS, & Li JW. [Comparison of therapeutic effects of different types of acupuncture interventions on herpes zoster in acute stage]. [Article in Chinese]. Zhen Ci Yan Jiu. 37(5):403-8.
  • 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.
  • Karner M, Brazkiewicz F, Remppis A, Fischer J, Gerlach O, Stremmel W, Subramanian SV, & Greten HJ. (2013). Objectifying specific and nonspecific effects of acupuncture: a double-blinded randomised trial in osteoarthritis of the knee. Evid Based Complement Alternat Med. 2013:427265.
  • Li J, Wang Q, Liang H, Dong H, Li Y, Ng EH, & Wu X. (2012). Biophysical characteristics of meridians and acupoints: a systematic review. Evid Based Complement Alternat Med. 2012:793841.
  • Lu W, & Rosenthal DS. (2013). Acupuncture for cancer pain and related symptoms. Curr Pain Headache Rep. 17(3):321.
  • Mao JJ, & Kapur R. (2010). Acupuncture in primary care. Prim Care., 37(1), 105-17.
  • NIH Consensus Development Program (November 3–5, 1997). “Acupuncture –Consensus Development Conference Statement”. National Institutes of Health.
  • Park SI, Sunwoo YY, Jung YJ, Chang WC, Park MS, Chung YA, Maeng LS, Han YM, Shin HS, Lee J, & Lee SH. (2012). Therapeutic Effects of Acupuncture through Enhancement of Functional Angiogenesis and Granulogenesis in Rat Wound Healing. Evid Based Complement Alternat Med. 2012:464586.
  • 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.
  • 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.
  • 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.
  • Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, Sherman KJ, Witt CM, Linde K; Acupuncture Trialists’ Collaboration. (2012). Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 172(19):1444-53.
  • Xu YH, Wang QY, Yu ZB, & He YW. (2010). Zhongguo Zhen Jiu., 30(11), 904-6.
  • 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.
  • Yang CP, Chang MH, Li TC, Hsieh CL, Hwang KL, & Chang HH. (2013). Predicting Prognostic Factors in a Randomized Controlled Trial of Acupuncture Versus Topiramate Treatment in Patients With Chronic Migraine. Clin J Pain. 2013 Jan 30. [Epub ahead of print]
  • 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.