Acupuncture: Are You Missing the Point?

Do you have minor aches and pains that have troubled you for years, or a nagging health condition from which you've yet to find relief? After you've exhausted the more traditional options, you just might feel like exploring complementary healing practices such as acupuncture.

No doubt you've heard stories that piqued your curiosity. "Spending 30 minutes with my acupuncturist cleared up 20 years of congestion." "After 1 month, my neck pain was gone." "It's what got me through chemo."

Anecdotal evidence is the norm with acupuncture because thousands of people have tried it, but very few scientifically valid studies have evaluated its effectiveness.

Now, with interest in complementary medicine on the rise, scientific studies on acupuncture are finally trickling in.

So what does the research say? Does acupuncture really work, or is it pointless? Answer the following question for insight.

Q: For which of the following ailments did a U.S. National Institutes of Health (NIH) panel find clear evidence supporting acupuncture's effectiveness?

A. postoperative nausea and vomiting
B. headache
C. carpal tunnel syndrome
D. addiction
E. asthma

The correct answer is: A. postoperative nausea and vomiting

Because so little conclusive research exists on the topic, the panel found a relatively small number of conditions and symptoms for which acupuncture may be useful, and then only when used in combination with conventional treatments. Better studies may be coming, but for now the NIH's exacting standards and a paucity of good research has resulted in a short list of proven applications for acupuncture.

The World Health Organization (WHO), a health association with members from around the world, offers a longer list of diseases, symptoms, and conditions for which acupuncture treatment may be effective.

Research continues in this area of complementary medicine, but in the meantime, why is the NIH list so short? The answer may lie in a look at East versus West.

Comparing Apples and Oranges

One major obstacle in evaluating the efficacy of acupuncture is its foundation in traditional Chinese medicine, which views anatomy, physiology, and illness differently from contemporary Western medicine.

Eastern medical philosophy attributes health problems to disruptions in the flow of essential energy -- or Qi -- through the body's invisible pathways, known as meridians. Chinese medicine uses acupuncture to correct this disruption and bring the body and mind back into balance.

However, modern medicine cannot identify and measure these forces, so scientific evidence cannot easily support claims of acupuncture's effectiveness.

Attempts to evaluate acupuncture using scientific research methods have been hampered by poor study design, small sample size, or other factors that produce unclear results. For example, it's difficult to create appropriate placebo conditions for studies. It's hard to fool patients with fake needles, and nonacupuncture points on the human body are few.

Q: Researchers have proposed several explanations for why acupuncture may work. Which of the following is NOT one of those explanations?

A. It activates the body's opioid system, stimulating the release of feel-good endorphins.
B. It stimulates glands, neurotransmitters, and hormones that facilitate physiological functions.
C. It activates the sweat glands to release toxins.
D. Its benefits are a result of the placebo effect.

The correct answer is: C. It activates the sweat glands to release toxins.

This is not one of the proposed explanations. Sweating helps regulate body temperature; it does not eliminate toxins. What's more, acupuncture does not appear to stimulate sweating.

Other explanations mentioned above involve the nervous system; many researchers believe acupuncture may influence this system, changing how people experience pain, how the body regulates itself, and how the body promotes its own physical and emotional well-being.

However, a much more likely explanation is that acupuncture works -- when it does work -- because of the placebo effect.

Although it is unclear if, how, or why acupuncture works, there is still a great deal of interest in the practice. It is one of the oldest and most commonly used medical practices in the world today, and a growing number of people are trying it.

If you find yourself going the way of the needle, there are a few things to think about when you make your appointment. First and foremost is safety.

Q: Which of the following is a potential adverse effect of acupuncture?

A. infection
B. central nervous system injuries
C. pneumothorax
D. hematoma
E. all of the above

The correct answer is: E. all of the above

Although rare, infections, nervous system injuries, local hematoma, and pneumothorax do occur. The estimated risk of a serious adverse event is about 0.05 events per 10,000 treatments and 0.55 events per 10,000 individual patients.

Also, acupuncture may pose complications for individuals who have pacemakers or bleeding disorders such as hemophilia, or who are taking blood thinners. If you have a preexisting medical condition, ask your healthcare team whether acupuncture treatment is safe for you. And you should clear any herbs an acupuncturist recommends with your healthcare provider.

Research does not support acupuncture as a primary treatment for any disease or ailment. Acupuncture works best with -- not in place of -- conventional medicine. Inform all of your healthcare providers before undergoing any treatment, and never stop a prescribed treatment or medication without permission from your prescribing physician.

If your healthcare provider believes acupuncture treatment could be helpful, ask him or her for a referral. Finding a good practitioner is key to a positive experience with acupuncture. A medical doctor with acupuncture training, a licensed acupuncturist, or a healthcare provider with an acupuncture license are all appropriate choices.

Once you've picked a good practitioner, it's helpful to become familiar with what's involved in a typical course of treatment. The initial consultation with an acupuncturist is usually quite different from a visit with a doctor.

Q: Which of the following is typically NOT part of the initial diagnostic visit?

A. discussion and question-and-answer session
B. examining your tongue
C. taking your temperature
D. taking your pulse

The correct answer is: C. taking your temperature

The initial consultation with an acupuncturist lasts much longer than a typical doctor visit. An acupuncturist may spend 15 to 20 minutes talking with you about your lifestyle, diet, sleep, emotions, family history, and many other things. During this time, he or she may observe the color of your face, your tongue, and the sound of your voice and take your pulse to determine an appropriate treatment.

Once treatment points are chosen based on this information, the acupuncturist will lightly place needles in the skin at the designated points for 15 to 30 minutes, possibly leaving you alone to relax. He or she will return to stimulate the needles, either by gently twisting them, by applying very low-level electrical stimulation, or by burning herbs at the exposed end of the needle (moxibustion).

Although less typical, acupuncturists also may use a variety of nonneedling methods during treatment, such as acupressure, shiatsu, cupping suction, magnets, low-frequency lasers, or even bee stings. However, research supporting these nontraditional methods is extremely scarce.

Fine needles remain the typical acupuncture tool of choice. These mysterious needles are one of the main reasons people hesitate to try acupuncture. This is understandable -- being stuck with a pin or a hypodermic needle can be painful. But are acupuncture needles the same?

Q: What are most modern acupuncture needles made of?

A. wood
B. glass
C. shell
D. stainless steel
E. stone

The correct answer is: D. stainless steel

The first needles were made from stone, but through the years various materials were used, including gold, silver, and bronze. Today, needles are usually made of stainless steel, and they are sterile, flexible, and disposable. They come in various lengths and widths, but most are a half inch to one-and-a-half inches long and only about the width of two strands of hair. They are not hollow like hypodermic needles, so they do not tear the skin in the same way.

Until the late 1980s, acupuncturists commonly sterilized needles in an autoclave for repeated use. However, the U.S. Food and Drug Administration now regulates acupuncture needles much like hypodermic needles. They are packaged individually or in units of fewer than 10 and are opened immediately before use. Once used, they are discarded in a biohazard container. All licensed practitioners are required to pass an exam demonstrating proper needle use.

So what do the needles feel like?

Q: After acupuncture treatments, people tend to feel which of the following?

A. tingly
B. sore
C. warm
D. numb
E. all of the above

The correct answer is: E. all of the above

Acupuncture patients report sensations ranging from nothing at all, to mild tingling, to slight numbness or soreness, to warmth at the site of insertion. Rarely is a person unable to tolerate acupuncture.

You may notice a dot of blood or even bruising at one or more needle sites. These are usually harmless, but talk to your acupuncturist if you are concerned. Acupuncture treatment sessions typically last about 50 minutes, but if you feel uncomfortable, you can end the session and have the needles removed.

A typical course of treatment is about 10 sessions, but this varies widely and is determined during the initial consultation and after each subsequent visit. After 4 to 6 sessions, your acupuncturist should be able to tell you whether the treatment is working.

But remember, acupuncture does not provide a cure; it may simply help control symptoms along with your doctor-prescribed treatment plan.

Also, not all insurance plans reimburse for acupuncture -- Medicare and Medicaid generally do not. Check with your insurance company before undergoing treatment.

Make an Informed Decision

Acupuncture is not for everyone. Before choosing to undergo treatment, it's important to understand that acupuncture might not work. Also, although associated risks are low, acupuncture can cause serious adverse effects in rare instances.

If you are considering it, make an informed decision by learning how medical acupuncture works for your condition, researching how cost-effective the treatment may be for you, and finding a licensed acupuncturist with whom you feel comfortable and safe.

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