Overview

Acupuncture is an important component of Traditional Chinese Medicine (TCM) that involves the insertion of thin needles at specific bodily points (acupoints), most of which are grouped according to their clinical effects on lines called meridians. The TCM theory of acupuncture is based in part on the premise that blood and energy termed qi (pronounced chee) circulate in a cyclical fashion through these meridians. This energy flow is required for good health; blockages in qi can lead to pain and/or ill health. (Many traditional Oriental medicine practices focus on improving the flow and balance of qi.) Thus, TCM practitioners will needle specific acupuncture points along the meridians to restore (or maintain) a healthy flow and balance of qi and blood in them.

TCM practitioners use acupuncture to treat and prevent a range of conditions and illnesses, even colds and flu. In the United States, one of its most common uses is to relieve pain, but it is also used for other conditions ranging from ear, nose and throat diseases to neurologic, respiratory or even psychiatric problems such as depression. Acupuncture may be used alone, in conjunction with other TCM therapies such as herbs, or with more conventional therapies.

Acupuncture as a therapeutic intervention is widely practiced in the United States. According to the 2007 National Health Interview Survey, which included a comprehensive survey of complementary and alternative medicine use by Americans, about 3.1 million adults and 150,000 children undergo the treatment each year. And the popularity of acupuncture is increasing over time; according to the same survey, acupuncture use increased by 1 million people between 2002 and 2007. People usually find the procedure to be relatively painless, although some points in some patients may be quite sensitive. Depending on your practitioner, the needles may be stimulated with manual manipulation, heat or electricity.

There are many state acupuncture organizations, and many states have acupuncture regulations and codes. Almost every state has a State Acupuncture Board, and there are approximately 50 accredited schools of acupuncture in the United States. There are also many physician-acupuncturists who practice acupuncture as part of their medical practices.

Widely practiced around the world, especially in Asia (the practice originated in China) and Europe, acupuncture didn’t gain a notable following in the United States until the 1970s, when New York Times journalist James Reston piqued public interest by writing about how physicians in Beijing eased his postsurgery abdominal pain with acupuncture. Acupuncture has been gaining popularity in the United States ever since.

The 1997 National Institutes of Health (NIH) Consensus Conference on Acupuncture gave a boost to acupuncture by concluding that acupuncture is safe and, for some conditions, proven effective. These include reducing nausea associated with chemotherapy, anesthesia or pregnancy and lessening the pain from dental surgery. There was also evidence suggesting acupuncture may be effective in treating migraines, depression, tennis elbow, constipation, low-back pain and infertility. Additionally, acupuncture may be useful in treating neck pain, asthma, insomnia and wound healing, among other conditions.

More recent evidence suggests that hypertension and certain cardiovascular diseases can likewise be improved by treatment with acupuncture. The NIH continues to fund a variety of research projects relating to the safety and effectiveness of acupuncture.

The World Health Organization (WHO), using different criteria, has recognized acupuncture as an appropriate treatment for more than 50 conditions, including certain digestive, respiratory, neurological, muscular, urinary, menstrual and reproductive disorders.

There are many styles of acupuncture practiced here, many of which are different from traditional Chinese acupuncture. “Medical acupuncture” refers to acupuncture practiced by a Western physician. Physicians as well as nonphysicians who are licensed to practice acupuncture (LAcs) will often use a variety of acupuncture styles. The most common style taught in American schools is called Traditional Chinese Medicine (TCM) acupuncture, but Five Element, Auricular and Neuro-anatomical acupuncture styles are also widely used. Scientists are finding it hard to reconcile the traditional explanation of how acupuncture works with standard Western medical models. Although several studies have documented acupuncture’s efficacy and effectiveness, much remains to be learned about its mechanisms of action from a Western perspective.

Human and animal studies show that acupuncture can generate various biological responses—some close to the insertion point and others at a distance. Research has demonstrated that acupuncture stimulates the body to release hormones, as well as naturally occurring opioid analgesics (termed endorphins and enkephalins) from the central nervous system. Endorphins diminish pain, influence the body’s self-regulating systems and promote physical and emotional well-being.

Associated mechanisms are also at work:

• Electromagnetic signals: Evidence suggests that acupuncture points are strategic conductors of electromagnetic signals, and acupuncture enables electromagnetic signals to be relayed at a greater rate than under normal conditions.
• Brain blood flow: Studies indicate that acupuncture clearly affects blood flow to centers of the brain and the central nervous system related to sensation and involuntary body functions, such as immune reactions and the regulation of blood pressure, blood flow, oxygenation and body temperature. Specific activation of certain brain regions, including some of the pain perception centers (such as the limbic area and hypothalamus) can be demonstrated during acupuncture treatments.

Ultimately, scientists don’t know exactly which mechanisms make acupuncture effective; more research is needed. It is often believed that to get the best results, treatments need to be individualized. That’s one of many reasons acupuncture is more difficult to research than a standard pharmaceutical medication.

Diagnosis

When is acupuncture an appropriate treatment? If you have pain, nausea and vomiting from chemotherapy or pregnancy, or are facing surgery and are worried about anesthesia-induced nausea, you may want to ask your health care professional about acupuncture. If you have had little or no success using conventional medicine, you may wish to ask your health care professional whether acupuncture might help. When the risks associated with conventional treatments are great or the outcomes uncertain, you might consider the safer option of acupuncture first. Often, acupuncture can be used effectively as a complementary therapy to conventional therapies.

For example, acupuncture is often used in combination with more conventional pain relievers. Some medical professionals report better results by combining acupuncture and certain conventional pain-killing drugs than from using the drugs alone. The NIH panel stated that there is clear clinical evidence that acupuncture provides relief from the nausea associated with chemotherapy, anesthesia or pregnancy, as well as post-operative dental pain. Recent research also has demonstrated acupuncture’s usefulness in treating migraine headaches, neck pain, low-back pain and knee osteoarthritis.

There are other situations in which research on acupuncture’s effectiveness is less convincing, yet still promising:

• addiction
• asthma
• fibromyalgia
• myofascial pain
• infertility
• insomnia
• tennis elbow

Studies suggest that acupuncture may also help relieve some of the physical problems associated with tension, stress, depression, anxiety and other emotional conditions.

The World Health Organization has taken a broader approach than U.S. organizations, recognizing acupuncture as appropriate for a wide range of conditions. Among them are:

• gastrointestinal disorders: ulcers, acute and chronic colitis, indigestion, constipation and diarrhea
• respiratory disorders: sinusitis, rhinitis, common cold, bronchitis, and asthma
• neurological disorders: headaches, migraine, trigeminal neuralgia, facial paralysis, frozen shoulder, neuralgia, sciatica, arthritis and Meniere’s disease
• poor eyesight
• urinary, menstrual and reproductive problems
• orthopedic disorders: tennis elbow, low-back pain, tendonitis and neck pain

One advantage of acupuncture is its extremely low incidence of major side effects—especially when compared to conventional medical treatments. The complications involved with acupuncture are similar but less common than the complications seen with other types of needle use. The most common side effects are local bruising or transient worsening of local pain. Rare side effects reported include disease transmission, infection, needle breakage, nerve damage or organ puncture. Major adverse events are extremely rare and are usually associated with poorly trained or unlicensed acupuncturists.

A Japanese study of 65,482 acupuncture treatments reported no major adverse effects, and another two surveys performed in the United Kingdom totaling 66,000 acupuncture treatments reported no serious adverse events. Also, in a prospective German study of 97,733 patients receiving acupuncture, the most frequently reported side effects were needling pain (3.3 percent) and hematoma (3.2 percent). The more serious events included two cases of collapsed lung. And an asthma attack, exacerbation of depression, acute high blood pressure and fainting were considered to be possibly related to treatment, but not definitely. Overall, acupuncture is considered very safe, and the risk of adverse effects is extremely low.

Finding an Acupuncturist

If you think acupuncture is for you, you may need to find a health care professional who is open to the possibility; many are skeptical. But there’s also a good chance that your health care professional will be able to refer you to a licensed practitioner. Don’t be surprised if you are referred to a physician: some neurologists, anesthesiologists and other physicians have training in acupuncture. Referrals for acupuncture from someone you trust are particularly important since state licensing and regulatory guidelines for acupuncturists vary widely.

Check to see if the acupuncturist you have chosen is licensed and/or credentialed. Approximately 40 states have established training standards for acupuncture certification.

Traditionally, acupuncture, even more than Western medicine, acknowledges the “art” of medicine. Therefore, recommendations from other health care providers, friends and family can be helpful.

Check treatment costs and insurance coverage. If your insurance company covers acupuncture treatment, it may have preferred providers or require pre-certification. Your physician or acupuncturist should inform you about the estimated number of treatments and the cost for each visit.

The First Visit

During your first visit, the acupuncturist will probably ask about the condition and symptoms that led you to seek acupuncture. Discuss any health conditions you have, especially pregnancy. Certain points shouldn’t be stimulated during pregnancy; you may risk uterine contractions, premature labor and a possible miscarriage.

Take a list of all the medications you are taking to share with the acupuncturist. For instance, if you are taking anticoagulants (blood-thinning drugs), you should warn the acupuncturist because you are more prone to bleeding complications (although acupuncture generally doesn’t draw blood). Also let the practitioner know if you have a pacemaker or any other implanted medical device.

The acupuncturist will ask about your medical history, but he or she will probably also ask questions seemingly unrelated to medicine. This holistic approach is typical of many alternative and complementary therapies. It’s the person, not only the symptoms and condition, who is being treated. The practitioner may take your pulse, examine your tongue and ears and touch (palpate) parts of your body. Ask about the treatment procedures that will be used and their likelihood of success for your condition or disease.

In the United States and Europe, the training and licensing of practitioners who provide acupuncture makes the spread of infectious diseases through the procedure extremely rare. If the practitioner is licensed, you can assume he or she knows how to protect you from infectious diseases spread by contaminated needles. Your acupuncturist should always use sterile, single-use disposable needles. This may not be true in underdeveloped countries.

Treatment

Here are some guidelines to follow before going for acupuncture treatment:

• Don’t eat an extremely heavy meal or drink alcohol right before or after your treatment.
• Don’t overexert yourself.
• Try to arrange your schedule so you can get some rest afterward, especially early on in the process. If you can’t, at least avoid scheduling activities that require you to be in top physical and mental condition. You may feel very relaxed or even tired after your session.
• Wear comfortable clothes.
• Continue taking your medications as directed by your health care professional, but make sure the acupuncturist knows what they are. Don’t ask advice from your acupuncturist to change or stop the medications because it is your primary care physician’s duty to oversee your medications.
• Don’t take illegal drugs. Drugs, as well as alcohol abuse, may seriously interfere with the effectiveness your treatment.

The average session may last from 15 minutes to an hour; your first one may take a bit longer. The number of treatments depends, of course, on your condition and how well you respond. For some chronic or complex problems, you may need one to two sessions a week for several months. Some conditions require maintenance therapy, just as they do in Western medicine.

As you are needled, you may feel something akin to a mosquito bite or perhaps a dull ache, numbness, tingling or a warm feeling. That is a normal reaction to the needle insertion. Sharp or severe pain is not.

If you’ve had bad experiences with shots and drawing blood, acupuncture will be different. Acupuncture needles are smooth and solid; hypodermic needles are hollow with cutting edges. This makes acupuncture needle insertion much less painful and reduces the likelihood of bruising. Needle phobias are common and sometimes non-needling techniques may be used for phobic patients or children. Acupuncture using lasers is gaining popularity as a painless way to provide treatments.

Once the needles are in place—they are usually left there for 10 to 15 minutes—you probably won’t feel anything. The acupuncturist may manually stimulate the needles, heat them or use electrical stimulation on them. Typically, the needles, which are much thinner than hypodermic needles, are inserted between one-quarter and one inch in depth. However, you need to stay relatively still and relaxed, because you could feel achy or tight in the needle spots if you move suddenly or tighten your muscles.

If you are uncomfortable, tell the acupuncturist. If you feel faint, dizzy or nauseated or become short of breath or break into a cold sweat, speak up. It’s often a function of nervousness, but your practitioner can readjust or withdraw the needles if necessary. Acupuncture, performed correctly, has almost no side effects. Your relief may be immediate or delayed for a few hours or up to three days, and you may notice dizziness, sleeplessness, nausea or euphoria. You may also have a little bleeding and bruising where the needles were inserted.

Some of these side effects may indicate the acupuncture is starting to work, and they don’t last for long. If they do, talk to your regular health care professional and your acupuncturist. Often, the first one or two treatments may leave you deeply relaxed or even mildly disoriented. You should take precautions while driving, especially after the first several sessions.

Emotionally speaking, most patients feel relaxed, energetic or even cheerful after treatment.

Make sure you keep your primary health care professional apprised of your acupuncture treatment. And keep your acupuncturist up to date on changes in your health. You may want to suggest that they talk to each other to reduce the chance that important medical problems will be overlooked.

The National Center for Complementary and Alternative Medicine (part of the National Institutes of Health) has studied or is continuing to research the use of acupuncture in the following areas:

• How exactly acupuncture works, such as what happens in the brain during treatment
• Acupuncture and its use in treating pain
• Acupuncture to help treat post-traumatic stress disorder
• Whether acupuncture works for specific health conditions, such as chronic low-back pain, headache and osteoarthritis of the knee
• The use of acupuncture to relieve the side effects of hormone replacement therapy
• Ways to better understand and identify the potential neurological properties of meridians and acupuncture points
• Methods and instruments that can improve the quality of acupuncture research
• The use of acupuncture in improving pregnancy rates following IVF

Researchers hope to show that acupuncture at certain acupoints produces long-lasting blood pressure reductions in hypertensive patients but not in subjects with normal blood pressure. To be of clinical value, acupuncture must provide an antihypertensive effect that persists in a cost-efficient manner.

Encouraging research continues on potential acupuncture treatments for dental surgery pain, attention deficit hyperactivity disorder, asthma, bronchitis, myocardial infarction and rehabilitation from stroke and other conditions.

Prevention

Acupuncture is considered a form of treatment or therapy. However, acupuncture practitioners believe that acupuncture may be most successful when it is applied as an early intervention for symptoms or conditions. In theory, acupuncture can prevent or reverse some diseases, or at least prevent them from worsening or becoming chronic. For example, research has shown a positive effect in preventing breech births among pregnant women. More research is needed to define the preventive value of acupuncture.

Facts to Know

1. Medical acupuncture refers to acupuncture performed by a physician trained and licensed in Western medicine.
2. The theory behind acupuncture in Traditional Chinese Medicine involves, in part, the regular flow of energy in the body. Various points on the body (acupuncture points) are connected by pathways, termed meridians. Traditional practitioners believe these meridians conduct energy, or qi, between the surface of the body and internal organs. Blockage of this energy may result in illness or disease. Acupuncture is said to unblock the meridians, allowing the energy to flow properly.
3. Studies show that acupuncture can relieve physical problems associated with tension, stress and other emotional conditions (such as depression).
4. You don’t have to believe in acupuncture for it to work, but you should at least be neutral to its effects.
5. Pregnant women may have acupuncture treatments, but they should always advise the acupuncturist of their condition. Stimulating certain acupuncture points, particularly those on or near the abdomen, could induce premature labor and possibly miscarriage.
6. About 3.1 million people in the United States undergo acupuncture each year.
7. While studies have documented acupuncture’s efficacy, none have fully explained how it works in the context of Western medicine.
8. The World Health Organization has identified more than 50 conditions for which acupuncture can be used.
9. In general,you should avoid treatment when you are very hungry, full from a heavy meal or upset. Treatment can be adjusted according to a patient’s condition and symptoms.
10. Speak up during treatment. Let the acupuncturist know if you are nervous, uncomfortable, dizzy, nauseated or suffering any other ill effects. Your acupuncturist can adjust the needles or even withdraw them, if needed.

Key Q&A

1. Does acupuncture work the same for everybody?No. In fact, researchers aren’t completely sure how or why it works. Your response may be different than that of another patient with similar symptoms. Most patients have a favorable response to treatment, and none are made worse long-term.
2. Isn’t acupuncture just a placebo?No. While researchers don’t discount the placebo effect, evidence indicates that acupuncture is effective in treating a variety of conditions, including postoperative and chemotherapy-induced nausea and vomiting, pain associated with dental surgery, neck pain, low-back pain, migraines and knee osteoarthritis.
3. I know I want to try acupuncture. Why should I talk to my primary health care professional first?Pain may be a symptom of a serious condition. You should be screened by a health professional with formal training in Western allopathic medicine if the diagnosis is not clear or standard treatment options unknown.
4. Is acupuncture a replacement for conventional medicine?Sometimes, but generally, it is prudent to continue any current treatments prescribed for you. Acupuncture often serves as complementary therapy, working in conjunction with other treatments. In fact, in some cases, using acupuncture and certain conventional painkillers together leads to complete pain relief. And remember: If you are seeing several health care professionals, keep them all apprised of your various treatments and therapies.
5. Are the acupuncture needles like those used to give shots or draw blood?No. Acupuncture needles are hair-thin, smooth and solid, while hypodermic needles are thicker, hollow and have cutting edges.
6. When is acupuncture an appropriate treatment?If you have pain, nausea and vomiting from chemotherapy or pregnancy, or are facing surgery and worried about anesthesia-induced nausea, talk to your physician about acupuncture. You may also talk with an acupuncturist to get information. Acupuncture may offer pain relief or improve other symptoms even if you have had little success with conventional medicine.

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