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 abdominal pain after surgery. Research shows
that acupuncture is beneficial in treating a variety of health conditions.
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.
How Acupuncture works
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.
Uses for Acupuncture
Millions of people have used acupuncture for a variety of health conditions. The
treatment is often used in conjunction with more conventional methods and has gained wide
acceptance. American acupuncture incorporates a variety of approaches to diagnosis and
treatment that use medical traditions from China, Japan, Korea, and other countries. Many
scientific studies have confirmed its effectiveness. The most studied mechanism is the
stimulation of acupuncture points using needles, which are manipulated manually or with
electrical stimulation. Other stimulation techniques including pressure, heat, lasers, and
moxibustion (the burning of an herb at or near certain sites on the body), are also used,
but have not been the subject of many research studies. The World Health Organization
lists more than 40 conditions for which acupuncture may be indicated. These include
prevention and treatment of nausea, pain relief, treatment of addictions to alcohol,
tobacco, and other drugs, treatment of lung (pulmonary) problems such as asthma, and
rehabilitation from damage to the nervous system such as that caused by a stroke.
Pain relief
Acupuncture has been used successfully in the treatment of pain following surgery, and
in painful conditions of the muscles and skeleton. These include low back pain, tennis
elbow (epicondylitis), and a chronic inflammation of a muscle (fibromyositis). Studies
have shown that acupuncture stimulates the release of the body's natural pain-killing
chemicals, called endorphins, which are very effective in blocking pain. In animals,
transferring the fluid bathing the brain and spinal chord (cerebrospinal) from an animal
receiving acupuncture to another animal who is not, produces pain relief (analgesia) in
the recipient animal. In other controlled laboratory studies on people, acupuncture has
been shown to be more effective than a placebo. In a number of pain-related conditions,
acupuncture may be used along with other therapies. These include headache, menstrual
cramps, carpal tunnel syndrome, and asthma.
Nausea
Several studies have demonstrated that nausea caused by pregnancy, surgical anesthesia,
or chemotherapy treatment for cancer, is very responsive to acupuncture.
Addictions and AIDS
When acupuncture was used as part of a treatment program for substance abuse,
recipients had reduced cravings and improved psychological conditions. Symptoms of
withdrawal were less severe. In the treatment of Acquired Immune Deficiency Syndrome
(AIDS), acupuncture used with Chinese herbs has been helpful in improving the functioning
of the patient's immune system, and has reduced the severity of digestive problems,
fatigue, and other symptoms.
Other uses
Acupuncturists also cite success in treating a range of health problems including both
acute and chronic illnesses. Looking at the human body as a unity of body, mind, and
spirit, it is thought that those with physical problems reflect problems on the emotional
or spiritual levels as well. If underlying factors are not detected and treated, symptoms
will persist and/or problems in other areas may develop.
Acupuncture treatment for sudden injuries, such as sprained ankles or other muscle,
ligament, or tendon misalignments, is said to be most effective when treatment is received
before "sleeping on it." Acupuncture is thought to restore the body to its
original form or "memory" for these and chronic illnesses.
Description of Acupuncture
The procedure involves the insertion of fine needles, made of stainless steel, gold, or
other metals, into specific points along the meridians of the body. The needles can be
heated, attached to a mild electric current, or twirled continuously with the hand. Some
needles are left in place for only a few minutes, while others remain for days. Pain
during treatment should be minimal. There may be a slight pricking sensation when a needle
is inserted but this does not last long. If there is some discomfort, it can be relieved
by a slight change in the position of the needle.
The number of treatments and the points chosen for a treatment depend on the patient
and the skills of the practitioner. Since Chinese medicine treats the whole patient, not
just the condition, each treatment is individualized.
Precautions before starting Acupuncture
There are instances where more traditional Western medicine is the treatment of choice,
including life threatening infection, severe trauma, or the need for surgical procedures,
such as open heart surgery. In China, this understanding has led to the practice of both
systems side by side, with the strengths of each system complementing the weaknesses of
the other. Acupuncture used in conjunction with Western procedures can speed the recovery
and rebalancing of the individual. In China, acupuncture is routinely used for anesthesia
in some types of major surgical procedures.
Caution is advised for the use of electrical acupuncture in patients with cardiac
pacemakers. The United States Food and Drug Administration regulates acupuncture needles
along with other medical devices such as surgical scalpels and hypodermic syringes,
requiring good manufacturing practices and single-use standards of sterility. Needle
insertion is considered an invasive procedure. Most states require an adequately trained
physician or a certified acupuncturist to perform and/or supervise the procedure. Although
the American Association of Medical Colleges reports that no medical school in the United
States provides acupuncture training, some chiropractic schools have elective 200 hour
programs. The American Holistic Medical Association has developed a 300 hour program for
physicians, although some experts in the field feel that these programs do not allow for
full mastery of the materials and skills involved. Several programs located throughout the
country offer rigorous comprehensive preparation that may take as long as 36 months and
include a clinical residency, with 500 hours of supervised clinical work before licensure
is granted. As of 1998, non-physician acupunturists, including dentists, podiatrists, and
chiropractors, were licensed, registered, or certified in 34 states plus the District of
Columbia. The National Commission for the Certification of Acupuncturists offers a
competency test that is used in some states. Since not all states regulate the profession,
checking on credentials is important.
Risks associated with acupuncture
Serious side effects are unusual, but localized congestion is frequently reported after
needle insertion. Less commonly reported adverse effects may include fainting, black and
blue marks (hematoma formation), and a collapsed lung.
One of the advantages of acupuncture is that the incidence of negative side effects is
lower than that of many drugs or other accepted medical procedures that can be used as
treatment for the same conditions. |
