Acupuncture
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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 abdominal
pain after surgery. Research shows that acupuncture is beneficial in treating
a variety of health conditions.
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. A Harvard University study published in 1998 estimated that Americans
made more than five million visits per year to acupuncture practitioners. 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.
NIH has funded a variety of research projects on acupuncture. These grants
have been awarded by the National Center for Complementary and Alternative
Medicine (NCCAM), the Office of Alternative Medicine (OAM, NCCAM's predecessor),
and other NIH Institutes and Centers.
This Research Report provides general information about acupuncture, research
summaries, and a resource section. Terms that are underlined are defined at
the end of this report.
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Traditional
Chinese medicine theorizes that there are more than 2,000 acupuncture
points on the human body, and that these connect with 12 main and 8 secondary
pathways called meridians.
Chinese medicine practitioners believe these meridians conduct energy, or
qi (pronounced "chee"),
throughout the body.
Qi is believed to regulate spiritual, emotional, mental, and physical balance
and to be influenced by the opposing forces of yin and yang. According
to traditional Chinese medicine, when yin and yang are balanced, they work
together with the natural flow of qi to help the body achieve and maintain
health. Acupuncture is believed to balance yin and yang, keep the normal flow
of energy unblocked, and maintain or restore health to the body and mind.
Traditional Chinese medicine practices (including acupuncture, herbs, diet,
massage, and meditative physical exercise) all are intended to improve the
flow of qi.
Western scientists have found meridians hard to identify because meridians
do not directly correspond to nerve or blood circulation pathways. Some researchers
believe that meridians are located throughout the body's connective tissue; others
do not believe that qi exists at all. Such
differences of opinion have made acupuncture an area of scientific controversy.
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Several processes have been proposed to explain acupuncture's effects, primarily
those on pain. Acupuncture points are believed to stimulate the central nervous
system (the brain and spinal cord) to release chemicals into the muscles, spinal
cord, and brain. These chemicals either change the experience of pain or release
other chemicals, such as hormones, that influence the body's self-regulating
systems. The biochemical changes may stimulate the body's natural healing abilities
and promote physical and emotional well-being. There
are three main mechanisms:
- Conduction of electromagnetic
signals: Western scientists have found evidence that acupuncture
points are strategic conductors of electromagnetic signals. Stimulating
points along these pathways through acupuncture enables electromagnetic
signals to be relayed at a greater rate than under normal conditions.
These signals may start the flow of pain-killing biochemicals, such as
endorphins, and of immune system cells to specific sites in the body
that are injured or vulnerable to disease.
- Activation of opioid systems: Research has found that several types
of opioids may
be released into the central nervous system during acupuncture treatment,
thereby reducing pain.
- Changes in brain chemistry, sensation, and involuntary body functions: Studies
have shown that acupuncture may alter brain chemistry by changing the release
of neurotransmitters and neurohormones.
Acupuncture also has been documented to affect the parts of the central nervous
system related to sensation and involuntary body functions, such as immune
reactions and processes whereby a person's blood pressure, blood flow, and
body temperature are regulated.
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.
According to the NIH
Consensus Statement on Acupuncture:
Acupuncture as a therapeutic intervention is widely practiced in
the United States. While there have been many studies of its potential usefulness,
many of these studies provide equivocal results because of design, sample size,
and other factors. The issue is further complicated by inherent difficulties
in the use of appropriate controls, such as placebos and
sham acupuncture groups. However, promising results have emerged, for example,
showing efficacy of acupuncture 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. Further research
is likely to uncover additional areas where acupuncture interventions will
be useful.
Increasingly, acupuncture is complementing conventional therapies. For example,
doctors may combine acupuncture and drugs to control surgery-related pain in
their patients. By
providing both acupuncture and certain conventional anesthetic drugs, some
doctors have found it possible to achieve a state of complete pain relief for
some patients. They
also have found that using acupuncture lowers the need for conventional pain-killing
drugs and thus reduces the risk of side effects for patients who take the drugs.
Currently, one of the main reasons Americans seek acupuncture treatment is
to relieve chronic pain, especially from conditions such as arthritis or lower
back disorders. Some
clinical studies show that acupuncture is effective in relieving both chronic
(long-lasting) and acute or sudden pain, but other research indicates that
it provides no relief from chronic pain. Additional
research is needed to provide definitive answers.
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The U.S. Food and Drug Administration (FDA) approved acupuncture needles for
use by licensed practitioners in 1996. The FDA requires manufacturers of acupuncture
needles to label them for single use only. Relatively
few complications from the use of acupuncture have been reported to the FDA
when one considers 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. When not
delivered properly, acupuncture can cause serious adverse effects, including
infections and punctured organs.
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NCCAM and OAM have supported scientific research to find out more about acupuncture.
Examples of recent NCCAM-supported projects include:
- Studying the safety and effectiveness of acupuncture treatment for osteoarthritis
of the knee.
- Investigating whether electroacupuncture works for chronic pain and inflammation
(and, if so, how).
- Finding out how acupuncture affects the nervous system, by using MRI (magnetic
resonance imaging) technology.
- Bringing together leaders from the Oriental medicine and conventional
medicine communities to collaboratively study the safety and effectiveness
of acupuncture and further develop the standards for clinical trials.
- Studying whether acupuncture can decrease the release of adrenalin in
heart patients and improve their survival and quality of life. Adrenaline
can make the heart beat faster and can thereby contribute to heart failure.
- Looking at the effectiveness of acupuncture for treating high blood pressure.
- Studying the effects of acupuncture on the symptoms of advanced colorectal
cancer.
- Testing the safety and effectiveness of acupuncture for a type of depression
called major depression.
With regard to earlier findings, researchers at the University of Maryland
in Baltimore, with the support of OAM, conducted a randomized
controlled clinical trial and found that patients treated with acupuncture
after dental surgery had less intense pain than patients who received a placebo. Scientists
at the university also found that older people with osteoarthritis experienced
significantly more pain relief after using conventional drugs and acupuncture
together than those using conventional therapy alone OAM
also funded several preliminary studies on acupuncture:
- In one small randomized controlled clinical trial, more than half of 11
women with a major
depressive episode who were treated with acupuncture improved significantly.
- In another controlled clinical trial, nearly half of the seven children
with attention
deficit hyperactivity disorder who underwent acupuncture treatment showed
some improvement in their symptoms. Researchers concluded that acupuncture
was a useful alternative to standard medication for some children with this
condition.
- In a third small controlled study, eight pregnant women were given a type
of acupuncture treatment called moxibustion to
reduce the rate of breech births, in which the fetus is positioned for birth
feet-first instead of the normal position of head-first. Researchers found
the treatment to be safe, but they were uncertain whether it was effective. Then,
researchers reporting in the November 11, 1998, issue of the Journal of
the American Medical Association conducted a larger randomized controlled
clinical trial using moxibustion for breech births. They found that moxibustion
applied to 130 pregnant women presenting breech significantly increased the
number of normal head-first births.
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The use of acupuncture, like the use of many other complementary
and alternative medicine (CAM) treatments, has produced a good deal of anecdotal
evidence. Much of this evidence comes from people who report their own
successful use of the treatment. If a treatment appears to be safe and patients
report recovery from their illness or condition after using it, others may
decide to use the treatment. However, scientific research may not support
the anecdotal reports.
Lifestyle, age, physiology, and other factors combine to make every person
different. A treatment that works for one person may not work for another who
has the very same condition. You as a health care consumer (especially if you
have a preexisting medical condition) should discuss any CAM treatment, including
acupuncture, with your health care practitioner. 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 and have had
little or no success using conventional medicine, you may wish to ask your
doctor whether acupuncture might help.
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Health care practitioners can be a resource for referral to practitioners
of acupuncture, as more are becoming aware of this CAM therapy. More medical
doctors, including neurologists, anesthesiologists, and specialists in physical
medicine, are becoming trained in acupuncture, traditional Chinese medicine,
and other CAM therapies. In addition, national organizations (consult your
local library or search with a Web browser) may provide referrals to practitioners,
although some organizations may encourage the use of their practices.
- Check a practitioner's credentials.
A 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.
- Check treatment cost and insurance coverage.
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 nonphysician practitioners.
Check with your insurer before you start treatment as to
whether acupuncture will be covered for your condition, and
if so, to what extent. Some plans require preauthorization
for acupuncture.
- Check treatment procedures.
Ask about the treatment procedures that will be used and their
likelihood of success for your condition or disease. You
also should make certain that the practitioner uses a new
set of disposable needles in a sealed package every time.
The FDA requires the use of sterile, nontoxic needles that
bear a labeling statement restricting their use to qualified
practitioners. The practitioner also should swab the puncture
site with alcohol or another disinfectant before inserting
the needle.
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 the
condition. Inform the acupuncturist about all treatments or
medications you are taking and all medical conditions you have.
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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. This
is why it is important to seek treatment from a qualified acupuncture practitioner.
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NCCAM Clearinghouse
CAM on PubMed
National Institutes of Health (NIH)
Combined Health Information Database (CHID)
ClinicalTrials.gov
Computer Retrieval of Information on Scientific Projects (CRISP)
NIH Consensus Program Information Center
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