A focus on acupuncture treatment

Introduction

 

While conventional medicine excels at treating acute conditions and managing chronic ones, it can fall short for some patients due to various reasons such as individual differences in response to treatment, or limitations in available therapies. It can also fall short for those seeking holistic well-being or addressing complex conditions with unclear root causes. As a result they might explore complementary and alternative medicine (CAM), which encompasses diverse practices aiming to restore balance and promote self-healing. CAM options include herbal remedies, dietary changes, massage therapy, yoga, meditation, and acupuncture. The National Center for Complementary and Integrative Health¹ offers a wealth of information on the subject and the primary care provider may direct patients to anyone or a combination of these options. In this discussion we will focus primarily on acupuncture, its basis and validity, its utility and limitations, and the resources available for patients to make a rational choice based on their personal situation.

 

¹National Center for Complementary and Integrative Health

 

 

Historical perspective

 

Acupuncture, an ancient Chinese medical technique dating back over 2,500 years, has made a remarkable journey from the East to the West. Initially shrouded in mystery and met with skepticism by Western-trained physicians, it has gradually gained acceptance as an alternative or complementary therapy. Acupuncture emerged in ancient China before 2500 BCE. It is rooted in Chinese philosophy’s dualistic cosmic theory of yin (passive, represented by the earth) and yang (active, represented by the heavens). According to this philosophy, health results from balancing these forces. Disease occurs due to their imbalance, obstructing the life force or qi. Acupuncture aims to restore harmony by influencing the distribution of yin and yang through specific points on the body called meridians.

 

Jesuit missionaries in China first introduced acupuncture to Europe in the 16th century, sparking initial interest but limited adoption. European physicians like Willem ten Rhijne ² documented acupuncture techniques, influencing the development of the modern hypodermic needle. The 19th century saw declining interest in Europe due to the rise of biomedicine and skepticism about its theoretical basis. The 20th century witnessed renewed interest starting with the work of George Soulié de Morant³, a French diplomat stationed in China, who extensively studied acupuncture and Chinese medicine. He translated ancient Chinese texts on acupuncture into French, helping to popularize the practice in the West. Another turning point came in 1971 when James Reston, a famed journalist, underwent an emergency appendectomy in China. After surgery he received acupuncture for pain relief. His positive experience related in an article⁴ in the New York Times in 1971 was credited with catalyzing further interest⁵. Richard Nixon's 1972 visit to China and subsequent cultural exchanges was no less important. Interest in acupuncture practice, scientific research and clinical trials bloomed and led to the level of acceptance we see today.

 

²Willem ten Rhijne, Wikipedia

³George Soulié de Morant, Wikipedia

⁴Reston, James (July 26, 1971). "Now, About My Operation in Peking" (PDF). The New York Times

⁵Johnson, Ian (September 23, 2016). "An Expert on Chinese Medicine, but No New Age Healer". The New York Times. ISSN 0362-4331

 

 

Acceptance & Integration into Healthcare

 

Today, acupuncture is recognized as an alternative or complementary medical practice by licensed healthcare professionals in many Western countries. In the United States, the 1997 National Institutes of Health (NIH) Consensus Conference⁶ formally acknowledged acupuncture's effectiveness for pain management and other conditions. It was a landmark recognition. Acupuncture is regulated by state laws, and acupuncturists must meet specific education and training requirements to become licensed.

 

Renowned organizations like the American College of Traditional Chinese Medicine⁷ (ACTCM) and the National Certification Commission for Acupuncture and Oriental Medicine⁸ (NCCAOM) ensure practitioner competence. The NCCAOM provides certification for acupuncturists⁹, ensuring they meet national standards of competency and safety. Additionally, many Western medical institutions now offer acupuncture as part of their integrative medicine programs, further solidifying its acceptance in Western healthcare.

 

Many insurance plans offer partial or full coverage for acupuncture¹⁰, further solidifying its acceptance as a legitimate medical practice. Over 20 million Americans use acupuncture annually¹¹, with approximately 33,000 certified or licensed acupuncturists practicing in all 50 states. Over the past two decades, acupuncture has grown in popularity, making it one of the most widely used and accepted complementary and alternative medicine (CAM) therapies after chiropractic.

 

⁶NIN Consensus Development Panel on Acupuncture. Acupuncture. JAMA. 1998;280(17):1518–1524. doi:10.1001/jama.280.17.1518

⁷American College of Traditional Chinese Medicine

⁸National Certification Commission for Acupuncture and Oriental Medicine

⁹The NCCAOM® Certification in Acupuncture

¹⁰How much does acupuncture cost? Arnesa A. Howell, GoodRx Health, March 30, 2022

¹¹How popular is acupuncture? Brennen McKenzie in Science-Based Medicine, March 25, 2011

 

Scientific validation

 

Several significant clinical trials have been conducted to evaluate the efficacy of acupuncture for various conditions. For chronic pain, data from 12 studies indicated acupuncture was more effective than no treatment for back and neck pain. Additionally, research suggests acupuncture might offer comparable pain relief to nonsteroidal anti-inflammatory drugs (NSAIDs) for these conditions. Studies on headaches and migraines also show potential, with reviews indicating acupuncture may be slightly more effective than medication for preventing migraines and have fewer side effects¹². Moreover, the Acupuncture Trialists' Collaboration conducted a meta-analysis of individual patient data from nearly 18,000 patients in 29 high-quality randomized controlled trials (RCTs) and found that acupuncture was effective for chronic pain conditions such as headache, osteoarthritis, and musculoskeletal pain¹³. Another notable study published in JAMA in 2017 examined the use of acupuncture for chronic pain and concluded that acupuncture was associated with significant reductions in pain compared with sham acupuncture and no acupuncture control groups¹⁴. These trials provide strong evidence supporting the use of acupuncture for certain conditions, particularly chronic pain.

 

However, it's important to note that the differences between acupuncture and sham acupuncture (placebo) can be small for some conditions, and further research is needed to understand the mechanisms behind its effectiveness. Despite over 14,900 published randomized controlled trials (RCTs) in acupuncture, skepticism persists regarding the evidence supporting its efficacy. Challenges in designing high-quality acupuncture trials include issues related to study design, applicability, and reporting. To address these concerns, an international panel of experts, including patients, clinicians, and researchers, developed new guidance for RCTs in acupuncture. This guidance emphasizes rigorous trial design and evaluation of submitted proposals and completed trials¹⁵. Additionally, placebo control methods have been explored to enable meaningful evaluation of acupuncture’s efficacy¹⁶. While acupuncture remains a complex and multifaceted intervention, efforts continue to improve the evidence base and enhance its acceptance in clinical practice.

 

 

¹²NCCIH: Acupuncture: What You Need To Know

¹³Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012;172(19):1444-53. doi: 10.1001/archinternmed.2012.3654. PMID: 22965186; PMCID: PMC3658605.

¹⁴Vickers AJ, Vertosick EA, Lewith G, MacPherson H, Foster NE, Sherman KJ, et al. Acupuncture for chronic pain: update of an individual patient data meta-analysis. J Pain. 2018;19(5):455-74. doi: 10.1016/j.jpain.2017.11.005. PMID: 29287983; PMCID: PMC5931146.

¹⁵Zhang YQ, Jiao RM, Witt CM, et al. How to design high-quality acupuncture trials—a consensus informed by evidence. BMJ. 2022;376:e0674761

¹⁶Placebo Devices as Effective Control Methods in Acupuncture Clinical Trials. PLOS ONE. 2015;10(11):e01408252

 

Best indications

 

Insights based on available data and expert opinions^17,18 provide the basis for the following ranking.

 

Top Contenders:

Chronic Pain:Back pain, neck pain, knee pain from osteoarthritis, and headaches (including migraines and tension headaches) consistently rank high due to their prevalence and acupuncture's proven effectiveness in pain management.

Nausea and Vomiting: Post-operative and chemotherapy-induced nausea/vomiting are common issues with well-established evidence for acupuncture's beneficial impact.

 

Following Closely:

Allergic Rhinitis: Seasonal allergies affect a significant portion of the population, making acupuncture an attractive option due to its potential for natural symptom relief.

Stroke Rehabilitation: As stroke rehabilitation focuses on recovery, acupuncture's potential to improve motor function and reduce spasticity attracts patients and practitioners.

 

Other favorites:

Cancer Symptoms: Acupuncture is increasingly used alongside conventional cancer treatments to reduce pain.

Herpes Zoster infection: The results of at least 22 clinical trials¹⁹ has confirmed that acupuncture is as effective as standard medications in pain management.

Musculoskeletal Disorders: Conditions like fibromyalgia, tennis elbow, and carpal tunnel syndrome have shown some positive responses to acupuncture treatment.

Anxiety, Depression & Post traumatic stress disorder (PTSD): Many patients seek acupuncture as a complementary therapy for managing symptoms of anxiety, depression & PTSD²⁰.

Insomnia: Acupuncture's potential to improve sleep quality and address insomnia makes it a sought-after treatment for individuals struggling with sleep disorders

Dysmenorrhea (Menstrual Pain): While acupuncture may be sought after for menstrual pain relief, it may not be as commonly practiced for this indication compared to other conditions.

 

This is not an exhaustive list, and individual preferences and practice landscapes can vary greatly. Consulting with licensed acupuncturists and healthcare professionals remains crucial for making informed decisions about your specific needs.

 

¹⁷Van Hal M, Dydyk AM, Green MS. Acupuncture. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532287/

¹⁸WHO benchmarks for the practice of acupuncture

¹⁹Choi S, Moon J, Jang W, Jang J, Park S, Sung W, Jung C, Seo B, Lee S, Kim K, Kim E.  The Effectiveness of Acupuncture for Herpes Zoster: A Systematic Review and Meta-Analysis.  J Acupunct Res 2023;40:16-34.  https://doi.org/10.13045/jar.2022.00416

²⁰British Acupuncture Council: Post traumatic stress disorder, Fact Sheet (2019)

 

Key Resources

 

You primary care provider: no changes in health care should be undertaken without first consulting with your primary care provider who in principle should have a comprehensive understanding of your status and could make appropriate recommendations,

The National Center for Complementary and Integrative Health (NCCAOM)/ Acupunture: What you need to know.

The National Center for Complementary and Integrative Health (NCCAOM)/ Acupuncture

American Academy of Medical Acupuncture: Health Conditions Treated by Acupuncture

Holistic Health Oxford: The World Health Organisation recommends acupuncture for over 100 conditions

 

Directories of acupuncture practitioners:

American Society of Acupuncturists: Find a Practitioner

WebMD: Find Top Acupuncturists by State

NCCAOM: Find a Practitioner

 

Of course, carefully reading all of the above could only help.

 

 

Dedications

 

With admiration and gratitude to

 

Dr. Le Thi-Nguyen Quoc

Primary Care & Acupuncturist

 

Dr Tran Van (1906-2003)

Pediatrician & Acupuncturist

 

Who both introduced me to acupuncture as a patient