Does Acupuncture work ?

For specific information detailing some research articles on this condition and Acupuncture, please read below.

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Acupuncture at the Jane B. Pettit Comprehensive Pain Management Center. (Located at the Pain Management Center at Children’s Hospital of Wisconsin, a major affiliate of the Medical College of Wisconsin).

The pain management center has used acupuncture with success in treating conditions such as:

· fibromyalgia (a chronic pain condition affecting muscles and connective tissues)

According to a National Institutes of Health panel, convened in November of 1997, clinical studies have shown that acupuncture is helpful in treating nausea caused by surgical anesthesia and cancer chemotherapy, dental pain after surgery, addiction, headaches, menstrual cramps, tennis elbow, fibromyalgia, myofascial (connective tissue) pain, osteoarthritis, lower back pain, carpal tunnel syndrome, asthma, and to assist in stroke rehabilitation.

The World Health Organization lists more than 40 conditions for which acupuncture may be used.

More and more, acupuncture is being used to supplement other forms of treatment, which is one reason patients often turn to a physician who has training in both Western medicine and acupuncture. Organizations such as the American Academy of Medical Acupuncture, National Acupuncture and Oriental Medicine Alliance. and American Association of Oriental Medicine provide lists of credentialed acupuncture practitioners.

Lynn M. Rusy, MD
Associate Professor of Anesthesiology
Medical College of Wisconsin

Associate Director
Jane B. Pettit Comprehensive Pain Management Center
Children’s Hospital of Wisconsin.Article Created: 2001-04-12
Article Updated: 2001-07-25

Acupuncture reduces symptoms associated with fibromyalgia, according to a Mayo Clinic study involving 50 fibromyalgia patients. Fibromyalgia is an arthritis-related disorder with symptoms of widespread musculoskeletal pain, joint pain and stiffness, and fatigue.

In the randomized, controlled Mayo Clinic study, symptoms of the group receiving acupuncture significantly improved versus the control group.

Researchers at University College London and Southampton University say they have separated out this placebo effect.

Their findings, based on a series of experiments and brain scan results, are published in the journal NeuroImage.

The researchers used positron emission tomography (PET) scans to see what was happening in the brains of people having acupuncture treatment for arthritis pain. Each of the 14 volunteers underwent each of three interventions in a random order.

In one intervention, patients were touched with blunt needles but were aware that the needle would not pierce the skin and that it did not have any therapeutic value.

Another intervention involved treatment with specially developed "trick" needles that give the impression that the skin was being penetrated even though the needles never actually pierced the skin.

The needles worked like stage daggers, with the tip disappearing into the body of the needle when pressure is applied. This was designed to make the patients believed that the treatment was real.

When the researchers analysed the patients' PET scan results they found marked differences between the three interventions.

Only the brain areas associated with the sensation of touch were activated when the volunteers were touched with the blunt needles.

During the trick needle treatment, an area of the brain associated with the production of natural opiates - substances that act in a non-specific way to relieve pain - were activated.

This same area was activated with the real acupuncture but, in addition, another region of the brain, the insular, was excited by the treatment.

This was a pathway known to be associated with acupuncture treatment and thought to be involved in pain modulation.

Sarah Williams of the British Acupuncture Council said: "This is very positive news for acupuncture and this latest research is an exciting illustration of what acupuncturists have known for a long time - that acupuncture works."

"Low back pain is a common, impairing and disabling condition, often long-term, with an estimated lifetime prevalence of 70 percent to 85 percent," the authors write as background information in the article. "It is the second most common pain for which physician treatment is sought and a major reason for absenteeism and disability." Acupuncture is increasingly used as an alternative therapy.

Michael Haake, Ph.D., M.D., of the University of Regensburg, Bad Abbach, Germany, and colleagues conducted a randomized clinical trial involving 1,162 patients (average age 50) who had experienced chronic low back pain for an average of eight years. Patients underwent ten 30-minute sessions (approximately two sessions per week) of Vero acupuncture (387 patients), Shallow Needling Acupuncture (387 patients) or conventional therapy (388 patients). Vero acupuncture consisted of needling fixed points and additional points to a depth of 5 millimeters to 40 millimeters based on Traditional Chinese Medicine, while Shallow Needling Acupuncture consisted of inserting needles superficially (1 millimeter to 3 millimeters) into the lower back avoiding all known verum points or meridians.

Conventional therapy consisted of a combination of medication, physical therapy and exercise.

"A total of 13,475 treatment sessions were conducted (verum acupuncture, 4,821; Shallow Needling Acupuncture, 4,590; conventional therapy, 4,064)," the authors write:

Response rate was 47.6 percent in the verum acupuncture group, 44.2 percent in the Shallow Needling Acupuncture group, and 27.4 percent in the conventional therapy group,"

The superiority of both forms of acupuncture suggests a common underlying mechanism that may act on pain generation, transmission of pain signals or processing of pain signals by the central nervous system and that is stronger than the action mechanism of conventional therapy,"

the authors conclude. "Acupuncture gives physicians a promising and effective treatment option for chronic low back pain, with few adverse effects or contraindications. The improvements in all primary and secondary outcome measures were significant and lasted long after completion of treatment."

Daniel J. Mazanec, M.D., F.A.C.P., F.A.C.R., F.A.A.D.E.P. More than 1 million Americans are treated with acupuncture annually for musculoskeletal disorders including back pain and Fibromyalgia. Recent surveys reports 57% of rheumatologists and 69% of pain specialists have made referrals to practitioners of acupuncture. The author notes the recent NIH conference which concluded that acupuncture may be a "reasonable" treatment option for patients with low back pain.

The results of a recent study published in the Clinical Journal of Pain³ provide further proof that acupuncture is a safe and effective procedure for low-back pain, and that it can maintain positive outcomes for periods of six months or longer without producing the negative side-effects that often accompany more traditional pain remedies.

Drs. Christer Carlsson and Bengt Sj˜lund of the Lund University Hospital in Sweden recruited 50 patients (33 women, 17 main) from a tertiary level pain clinic for their study. The median age of the participants was 49.8; each patient had been suffering chronic low back pain for a minimum of six months and had tried a variety of other therapies (such as corsets, nerve blocks, drugs and physiotherapy) to treat their condition, but to no avail.

Subjects were randomly assigned to a manual acupuncture group, an electroacupuncture group or a placebo group. Treatment sessions lasted a total of 20 minutes each and were delivered once per week for eight weeks, with the same amount of time and care given to all patients in each group. A followup treatment was given after two months, and a tenth and final treatment was given after an additional two months.

In the manual group, local points on the lower back and distal points on the lower limbs, forearms and hands were used. The number of needles used per patient increased from an average of eight during the first session to as many as 18 during the third or fourth session. Needles were stimulated three times during each session to attain de qi.

A slightly different protocol was used on patients receiving electroacupuncture. Patients in this group received manual stimulation only during the first few sessions, followed by electrical stimulation of four needles in the low back in subsequent sessions. A similar number of needles as used in the manual acupuncture group were inserted and activated by hand.

The placebo group was given mock stimulation using what the researchers termed an "impressive" -- but disconnected - stimulator attached to two large electrodes. The electrodes were placed on the skin over the most painful areas in the lower back. During mock stimulation, flashing lamps from the machine were displayed and made visible to the patient to give the illusion that treatment was being delivered.

Figure III: Mean weekly pain intensity scores for acupuncture and placebo groups. Measurements were taken at baseline and at one-, three- and six-month follow-up assessments.. Throughout the study, patients recorded pain levels and other measurements in small booklets called pain diaries. Among the variables measured were pain intensity (recorded twice daily on a visual analog scale from 0 to 100, 100 being severe as possible); intake of analgesics (recorded daily); sleep quality (scored on a scale of "good," "slightly disturbed by pain" or "badly disturbed by pain"); and activity level. These diaries were compiled and their results analyzed by a nurse practitioner at the end of the study.

In addition, assessments were performed by an independent observer who did not know which type of acupuncture each patient received. These assessments were taken at four intervals: baseline, one month, three months and six months after the treatment period. These assessments consisted of a clinical interview and physical examination, after which the observer classified the patient's pain as improved, unchanged, or worse.

Analysis of the pain diaries revealed "significant" differences between acupuncture and placebo patients at the one-, three- and six-month intervals following treatment, all of which favored acupuncture as a more effective form of pain relief. For example, in the acupuncture group, both morning and evening pain scores were lower than baseline measurements and continued to decrease for the duration of treatment. In the placebo group, however, pain scores were several points higher after one month than they were at baseline, and continued to remain higher than the baseline scores throughout the study.

Activity levels were also markedly improved in the acupuncture group. Fourteen acupuncture patients and seven placebo patients had been on sick leave (either part-time or full-time) prior to the start of the study. By the time the tenth acupuncture treatment was delivered, six of the acupuncture patients on sick leave had returned to part-time or full-time work; another six were retired but still reported improved activity levels. In comparison, only one patient in the placebo group showed an improvement in activity; another patient actually regressed to being put on full sick leave.

Figure II: Acupuncture points used in the study. Points are labeled according to World Health Organization standards. Furthermore, acupuncture patients experienced less episodes of sleep disturbance than their placebo-treated counterparts. Before the study, 30 acupuncture patients and 12 placebo patients reported sleep disturbances due to pain. The researchers reported that the sleep pattern was "significantly less disturbed after the treatment period" in the acupuncture group, but that there was "no significant difference in sleep disturbance" in the placebo patients.

Finally, total intake of analgesics dropped dramatically in the acupuncture group, but not the placebo group. At the start of the study, patients in the acupuncture group consumed an average of 31 pills per week; those in the placebo group consumed an average of 23 pills. At the six-month follow-up, the number of pills taken by placebo patients remained almost identical (21.5 per person per week), but had dropped more than 28% to 21.4 pills per week in acupuncture patients.

Independent examination by the blinded observer appeared to corroborate the patients' pain estimates. One month after the initial treatment period, 16 acupuncture patients (but only two placebo patients) were judged to be improved. After six months, 14 acupuncture patients (and only two placebo patients) were still improved. Both types of acupuncture worked effectively; of the 14 patients who showed improvement after six months, eight received manual acupuncture and six received electrical stimulation.

Q: My doctor has recently suggested acupuncture. Is acupuncture safe and will it really help?

If the value of a treatment were based solely on how long it has been around, and how long people have thought that it was helpful, then acupuncture would probably be the most effective treatment known to humankind. Nonetheless, we still do not know why acupuncture works, how it works best, and for whom it is best used.

Many patients advocate acupuncture as a very effective treatment. Symptoms include pain from a variety of causes, as well as many other conditions including nausea, smoking cessation, problems with addiction, inflammatory conditions, even anxiety and depression, to name just a few.

There are many different forms of acupuncture. One form of acupuncture completed by one acupuncturist may be quite different than another, and any given practitioner may perform the acupuncture differently than another.

Taken all together, acupuncture is an ancient, time-tested form of therapy that seems to have exceptionally few side effects and appears to be safe for pain management.

In my experience, many patients have found relief from pain through acupuncture. For those of my patients who have not found relief with standard medical therapies, I am always open-minded to any treatment that will help, particularly those that have the fewest side effects. Thus, I embrace acupuncture. I look forward to revelations through science that better explain how it works and how it may be best applied to fight the war on pain.

Figure I: Total migraine symptoms at baseline, six and 12 months after initial treatment.

Migraines can be caused by a variety of physical and environmental factors, including diet, stress, allergens, menstruation, and changes in the weather.

They can last from a few minutes to several days, which in some cases may completely incapacitate the person suffering an attack.

Migraine headaches are also one of the leading causes of time missed from work. It is estimated that migraine sufferers lose more than 157 million workdays each year, leading to a loss of approximately 50 billion dollars per year due to absenteeism and medical expenses caused by headache. An additional four billion dollars a year is spent on pain relievers for migraines and other headaches, but many of these remedies either do not work as needed, or simply mask an underlying condition.

Figure II: Average per-patient migraine values at baseline, six and 12 months after initial treatment.

In one of the largest studies of its kind to date, a team of investigators in Italy examined the effectiveness of acupuncture versus a variety of pharmacological therapies in treating migraines. Their results, published in a recent issue of the Journal of Traditional Chinese Medicine,² revealed that patients given acupuncture experienced fewer migraine episodes, missed fewer days from work, and suffered no side effects compared to patients on conventional drug therapy. They also found acupuncture to be more cost-efficient, estimating a savings of hundreds of millions of dollars in private and social health expenditures if it were used to treat headaches alone instead of drugs.

A total of 120 subjects with a history of migraine headaches (without aura) were divided into two treatment groups of 60 patients each. The first group was treated with acupuncture (a maximum of three courses of 10 treatments twice a week, with a one-week break between each course). Acupuncture needles were applied to five points -- ST8; GB5; GB20; GV14; and LU7 -- with practitioners using the reducing method.

The second group of patients received drug therapy consisting of two or three treatments using a variety of pharmaceutical products (flunarizine; nimodipine; dihydroergotamine; lisuride; sumatriptam; or amitriptiline). A subgroup of pharmaceutical patients received a drug called longastatine, along with electrical stimulation.

All patients received a 30-minute medical examination at the beginning of the study, with 15-minute examinations at intervals of three, six and 12 months. For the month prior to the start of care, and for 12 months following the first course of treatment, patients were also given a set of monthly time-sheets and asked to track several criteria, including the duration and severity of symptoms; general psychological and physical condition; side-effects; and work absences.

To measure the daily impact of migraines, the researchers assigned values to the frequency, duration and severity of migraine symptoms. One unit of value was noted for each hour a patient had a migraine. If the migraine caused moderate pain, another unit was added; if the pain was intense, two units were added. Another unit was added if the migraine lowered the patient's quality of life during that hour; two units were added if the patient became bedridden because of the condition. At the end of each month, the units were totaled and expressed as a negative number, indicating the extent to which a patient's quality of life had been affected by migraine attacks.

Statistical analysis of the groups found that acupuncture improved the symptoms of migraine without aura "more significantly" than any type of pharmacological therapy. Total symptom scores in the acupuncture group dropped more than 7,800 points from the start of study to six months after the first treatment; in comparison, scores in the drug therapy group dropped less than 4,500. Twelve months after the start of the study, total symptoms scores for patients using drug therapy were still nearly twice those compared to subjects treated with acupuncture (see Figure I).

Figure IV: Side-effects experienced by drug therapy vs. acupuncture patients.

These variations were also seen on an individual patient basis (see Figures II and III). Six months after receiving their first treatment, the average migraine value for a patient in the drug therapy group was 65.45, a reduction of nearly 46% from the start of care. For those in the acupuncture group, however, the results were even more dramatic: the average acupuncture patient's migraine values decreased nearly 80%, from 163.72 at the start of the study to just 33.17 six months later. Acupuncture patients also experienced considerably fewer absences from work in the second six months of treatment compared to drug therapy patients.

One of the most significant aspects of the study was that even though patients were asked to document any side-effects from treatment, none were reported by participants in the acupuncture group. According to the investigators, "no negative sign was highlighted" by subjects receiving acupuncture, leading to the conclusion that "the total absence of side-effects after acupuncture treatment can be affirmed."

Patients in the drug therapy group did not appear to fare as well (see Figure IV). Of the 60 patients given pharmaceuticals, over three-quarters - 47 - reported side-effects ranging from nausea and diarrhea to flatulence and burning sensations. For instance, 16 of the 19 patients given flunarizine reported an unwanted weight gain of 3-4 kilograms; all 19 patients taking supatriptam, meanwhile, complained of difficulty breathing, nausea, stuffiness in the chest, and occasional vomiting.

In addition to patient values and pain scores, the researchers performed a cost-comparison of acupuncture and drug therapy, including the social costs for care (supported by the National Health Service); the cost to industry (due to absence from work); and the total private costs (paid by private citizens). The total costs for the acupuncture group were nearly 80 million lira less than expenditures for the drug therapy group (see Table I).

Table I: Comparison of social, private and total costs for acupuncture and drug therapy groups. Social costs are obtained by adding the costs of the National Health Service to the total cost of absences from work. One U.S. dollar equaled approximately 1,632 Italian lira at the time of the study.
Type of cost	Period	Cost of acupuncture group (in lira)	Cost of drug therapy group (in lira)
National Health Service	First six months Second six months Year	Lit 288,721 Lit (-)829,524 Lit (-)540,803	Lit 24,197,404 Lit 393,340 Lit 24,590,744
Absence from work	First six months Second six months Year	Lit 136,333,000 Lit 28,207,000 Lit 164,540,000	Lit 146,331,000 Lit 72,931,000 Lit 219,262,000
Social costs	Year	Lit 163,999,197	Lit 243,852,744
Private costs	First six months Second six months Year	Lit 21,228,320 Lit 1,449,640 Lit 22,677,960	Lit 16,581,650 Lit 6,179,850 Lit 22,761,500
Total	Year	Lit 186,677,157	Lit 266,614,244

The researchers then extrapolated the information gleaned from the two groups and applied that data to the total number of patients in Italy affected by migraines without aura (approximately 800,000) to determine the costs if every migraine patient were treated with just acupuncture or just pharmaceuticals. The results were overwhelmingly positive for acupuncture, with an estimated cost savings of more than a trillion lira (approximately $653 million in U.S. currency at the time of the study) compared to drug therapy.

Table II: Projected cost savings for migraine patients, acupuncture vs. drug therapy.
Costs	Acupuncture Group	Drug Therapy Group
National Health Service	Lit (-) 7,210,400,000	Lit 327,876,800,000
Absence from work	Lit 2,193,867,200,000	Lit 2,923,493,600,000
Total social cost	Lit 2,186,656,800,000	Lit 3,251,370,400,000
Private cost	Lit 302,372,800,000	Lit 303,486,400,000
Total cost	Lit 2,489,029,600,000	Lit 3,554,856,800,000
Projected total surplus	Lit 1,065,827,200,000 (appx. $653 million US)

While the value of acupuncture has gained a grudging acceptance by members of the medical community, few studies have examined the socioeconomic aspects of acupuncture compared to more "conventional" forms of care. The JTCM study addresses that issue while providing the groundwork for larger, more tightly controlled studies.

"Up to now, there has been neither precise data about these savings to the public, nor about the lack of risks for the patients treated with acupuncture for common diseases with a social cost," the investigators noted in their conclusion. "Today, thanks to this study, we have precise data which prove the exceptional usefulness of acupuncture."

The study also indicates that, contrary to those who would like to pigeonhole acupuncture into the realm of pain relief (and little else), it can do much more than just treat a painful condition. If research is conducted professionally and treatment is applied properly, acupuncture's reach can extend beyond the walls of a clinic or pain center to have a positive effect on a nation's social and financial well-being as well.

1. NHF Headache Facts. Available from the National Headache Foundation (www.headaches.org).

2. Liguori A, Petti F, Bangrazi A, Camaioni D, Guccione G, Pitari GM, Bianchi A, Nicoletti WE. Comparison of pharmacological treatment versus acupuncture treatment for migraine without aura - analysis of sociomedical parameters. J Tradit Chin Med 2000;20(3):231-40.

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