Why and How Acupuncture Works

Acupuncture has been studied for a variety of conditions and has been found to be effective for some. It is one of the oldest techniques to treat pain, though until now there has not been a lot of evidence to support its application for pain management in acute medical settings. It has been mainly used in the U.S. and other Western countries to ease low back pain, nerve pain, headaches, fibromyalgia, menstrual cramps and more.

Traditional acupuncture is understood to work by causing the release of endorphins, the body’s natural pain placating chemicals, when fine needles are inserted at specific locations in the skin, known as acupoints. It is also thought that acupuncture affects the part of the brain that governs serotonin, one of the key brain chemicals involved with mood.

In Chinese acupuncture, the acupuncturist may turn or twirl the needles slightly or apply heat or electrical stimulation to enhance the effects. A Japanese form of acupuncture involves more shallow needle insertion, and the needles aren't usually manipulated. Korean acupuncture focuses on applying needles to points in just the hands and feet.

According to a recent review of modern acupuncture procedure published in Harvard Healthbeat, the acupuncturist typically inserts four to 10 needles and leaves them in place for 10 to 30 minutes while you rest. A usual course of treatment includes six to 12 sessions over a three-month period. Acupressure, a similar technique, does not use needles. The acupressurist uses their hands to apply deep pressure at acupressure points.

Complication rates for acupuncture appear to be quite low. An analysis of acupuncture-related complications that had been reported in medical journals found that the most serious problem was accidental insertion of a needle into the fluid-filled space between the lungs and chest wall, known as the pleural cavity, but this is rare.

So how well might acupuncture work to fight acute pain? A new large randomized trial finds acupuncture, perhaps to the great surprise of many, to be superior to morphine in emergency department patients with pain.

The prospective, randomized trial of acupuncture vs. morphine to treat acute-onset moderate to severe pain was conducted in Tunisia in 300 emergency department patients. All had moderate to severe pain from a variety of causes.

Morphine was administered at an initial dose of 0.1 mg/kg, followed by half of that every five minutes until reaching a maximum dose of 15 mg, or a 50% or greater reduction in pain score. Acupuncture was performed according to a semi-standardized protocol.

A reduction in pain score  of greater than 50% was achieved more often in the acupuncture group compared to the morphine group—specifically 92% vs. 78%. The acupuncture group also experienced this pain reduction faster, with a mean time of 16 vs. 28 minutes. Minor adverse events were far more common in the morphine group (57%) than in the acupuncture group (3%).

So how is it that this ancient, drug-free pain management technique outperformed one of the most powerful painkilling drugs in modern use?

While prior studies confirm that acupuncture relieves pain, others show that it works no better than sham acupuncture, meaning procedures designed to mimic it but to have no real effect. One of the problems with deciphering results is that most acupuncture studies have been small. The design of sham acupuncture techniques has also varied widely, complicating any comparison. It is also possible that acupuncture works for some people and not others.

In addition to its role in endorphin release and serotonin regulation, acupuncture may work through a combination of placebo effect and social desirability bias, the term used in the social sciences to describe the tendency of survey respondents to answer questions in a manner that will be viewed favorably. But to dismiss acupuncture solely on those grounds is to, forgive the pun, miss the point.

In the midst of an opioid epidemic, it’s wise to consider non-pharmacological alternatives to manage pain in patients. It also seems that acupuncture is worth considering to treat pain in the growing population of polymedicated patients we know exist today, to avoid adverse drug reactions. And perhaps how it works is not as important as whether it works, given that it very seldom causes harm.

People who wish to try acupuncture should certainly seek out only an experienced acupuncturist. Licensing requirements vary from state to state. In states with no licensing requirements, find an acupuncturist with certification from the National Certification Commission for Acupuncture and Oriental Medicine, online at www.nccaom.org.

Harvard Healthbeat, Jul. 16, 2016

Am J Emerg Med, published online July 2016, http://www.ajemjournal.com/article/S0735-6757(16)30422-3/abstract

NEJM JW Gen Med, Oct 15, 2007

BMJ, 2007, Vol.  335, pp. 436

NCCAOM, www.nccaom.org

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