Acupuncture
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Key Points
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Acupuncture
originated in China more than 2,000 years ago,
making it one of the oldest and most commonly
used medical procedures in the world.
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It is important to
inform all of your health care providers about
any treatment that you are using or considering,
including acupuncture. Ask about the treatment
procedures that will be used and their
likelihood of success for your condition or
disease.
-
Be an informed
consumer and find out what scientific studies
have been done on the effectiveness of
acupuncture for your health condition.
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If you decide to
use acupuncture, choose the practitioner with
care. Also check with your insurer to see if the
services will be covered.
What is acupuncture?
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.
How widely is
acupuncture used in the United States
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.1
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.2
What does acupuncture
feel like?
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.3 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.
Is acupuncture safe?
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.5
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.6
Does acupuncture work?
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.8
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.
How might acupuncture
work?
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.9-14 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.15,16
How do I find a
licensed acupuncture practitioner?
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.
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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.17
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.
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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.
How much will
acupuncture cost?
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.
Will it be covered by
my insurance?
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
preauthorization for acupuncture. (For more
information, see NCCAM's fact sheet "Consumer
Financial Issues in Complementary and Alternative
Medicine")
What should I expect
during my first visit?
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.
Definitions
Complementary and
alternative medicine (CAM): A group of diverse
medical and health care systems, practices, and
products that are not presently considered an
integral part of conventional medicine.
Complementary medicine is used together with
conventional medicine, and alternative medicine
is used in place of conventional medicine. Some
health care providers practice both CAM and
conventional medicine.
Conventional
medicine: A whole medical system practiced by
holders of M.D. (medical doctor) or D.O. (doctor of
osteopathy) degrees and by their allied health
professionals, such as physical therapists,
psychologists, and registered nurses. Other terms
for conventional medicine include allopathy;
Western, mainstream, and orthodox medicine; and
biomedicine.
Fibromyalgia: A
complex chronic condition having multiple symptoms,
including muscle pain, fatigue, and tenderness in
precise, localized areas, particularly in the neck,
spine, shoulders, and hips. People with this
syndrome may also experience sleep disturbances,
morning stiffness, irritable bowel syndrome,
anxiety, and other symptoms.
Meridian: A
traditional Chinese medicine term for each of the 20
pathways throughout the body for the flow of qi, or
vital energy, accessed through acupuncture points.
Placebo: An
inactive pill or sham procedure given to a
participant in a research study as part of a test of
the effects of another substance or treatment.
Scientists use placebos to get a true picture of how
the substance or treatment under investigation
affects participants. In recent years, the
definition of placebo has been expanded to include
such things as aspects of interactions between
patients and their health care providers that may
affect their expectations and the study's outcomes.
Preclinical study:
A study done to obtain information about a
treatment's safety and side effects when given at
different doses to animals or to cells grown in the
laboratory.
Qi: A Chinese
term for vital energy or life force. In traditional
Chinese medicine, qi (pronounced "chee") is believed
to regulate a person's spiritual, emotional, mental,
and physical balance, and to be influenced by the
opposing forces of yin and yang.
Traditional Chinese
medicine (TCM): A whole medical system that was
documented in China by the 3rd century B.C. TCM is
based on a concept of vital energy, or qi, that is
believed to flow throughout the body. It is proposed
to regulate a person's spiritual, emotional, mental,
and physical balance and to be influenced by the
opposing forces of yin (negative energy) and yang
(positive energy). Disease is proposed to result
from the flow of qi being disrupted and yin and yang
becoming unbalanced. Among the components of TCM are
herbal and nutritional therapy, restorative physical
exercises, meditation, acupuncture, and remedial
massage.
References
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Culliton PD.
Current utilization of acupuncture by United
States patients. Abstract presented at: National
Institutes of Health Consensus Development
Conference on Acupuncture; 1997.
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Barnes PM, Powell-Griner
E, McFann K, Nahin RL. Complementary and
alternative medicine use among adults: United
States, 2002. CDC Advance Data Report #343.
2004.
-
American Academy
of Medical Acupuncture. Doctor, What's This
Acupuncture All About? A Brief Explanation.
American Academy of Medical Acupuncture Web
site. Accessed at
www.medicalacupuncture.org/acu_info/articles/aboutacupuncture.html
on December 14, 2004.
-
Lao L. Safety
issues in acupuncture. Journal of Alternative
and Complementary Medicine. 1996;2(1):27-31.
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U.S. Food and Drug
Administration. Acupuncture needles no longer
investigational. FDA Consumer.
1996;30(5). Also available at:
www.fda.gov/fdac/departs/596_upd.html.
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Lytle CD. An
Overview of Acupuncture. Rockville, MD: U.S.
Food and Drug Administration, Center for Devices
and Radiological Health; 1993.
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Berman BM, Lao L,
Langenberg P, et al. Effectiveness of
acupuncture as adjunctive therapy in
osteoarthritis of the knee: a randomized,
controlled trial. Annals of Internal Medicine.
2004;141(12):901-910.
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National
Institutes of Health Consensus Panel.
Acupuncture: National Institutes of Health
Consensus Development Statement. National
Institutes of Health Web site. Accessed at
odp.od.nih.gov/consensus/cons/107/107_statement.htm
on December 14, 2004.
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Eskinazi DP. NIH
Technology Assessment Workshop on Alternative
Medicine: Acupuncture. Gaithersburg, Maryland,
USA, April 21-22, 1994. Journal of
Alternative and Complementary Medicine.
1996;2(1):1-256.
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Tang NM, Dong HW,
Wang XM, et al. Cholecystokinin antisense RNA
increases the analgesic effect induced by
electroacupuncture or low dose morphine:
conversion of low responder rats into high
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Cheng XD, Wu GC,
He QZ, et al. Effect of electroacupuncture on
the activities of tyrosine protein kinase in
subcellular fractions of activated T lymphocytes
from the traumatized rats. Acupuncture and
Electro-Therapeutics Research.
1998;23(3-4):161-170.
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Chen LB, Li SX.
The effects of electrical acupuncture of Neiguan
on the PO2 of the border zone between ischemic
and non-ischemic myocardium in dogs. Journal
of Traditional Chinese Medicine.
1983;3(2):83-88.
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Lee HS, Kim JY.
Effects of acupuncture on blood pressure and
plasma renin activity in two-kidney one clip
Goldblatt hypertensive rats. American Journal
of Chinese Medicine. 1994;22(3-4):215-219.
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Okada K, Oshima M,
Kawakita K. Examination of the afferent fiber
responsible for the suppression of jaw-opening
reflex in heat, cold, and manual acupuncture
stimulation in rats. Brain Research.
1996;740(1-2):201-207.
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Takeshige C.
Mechanism of acupuncture analgesia based on
animal experiments. In: Pomerantz B, Stux G,
eds. Scientific Bases of Acupuncture.
Berlin, Germany: Springer-Verlag; 1989.
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Lee BY, LaRiccia
PJ, Newberg AB. Acupuncture in theory and
practice. Hospital Physician.
2004;40:11-18.
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White House
Commission on Complementary and Alternative
Medicine Policy: Final Report. March 2002.
White House Commission on Complementary and
Alternative Medicine Policy Web site. Accessed
at www.whccamp.hhs.gov/finalreport.html on
December 14, 2004.
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by: The National Center for
Complementary and Alternative
Medicine. Visit their
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