Because acupuncture needles penetrate the skin, many forms of acupuncture are invasive procedures, and therefore not without risk. Injuries are rare among patients treated by trained practitioners. In most jurisdictions, needles are required by law to be sterile, disposable and used only once; in some places, needles may be reused if they are first resterilized, e.g. in an autoclave.
Certain forms of acupuncture such as the Japanese Tōyōhari and Shōnishin often use non-invasive techniques, in which specially-designed needles are rubbed or pressed against the skin. These methods are common in Japanese pediatric use.
Common, minor adverse events
A survey by Ernst et al. of over 400 patients receiving over 3500 acupuncture treatments found that the most common adverse effects from acupuncture were:
Minor bleeding after removal of the needles, seen in roughly 3% of patients. (Holding a cotton ball for about one minute over the site of puncture is usually sufficient to stop the bleeding.)
Hematoma, seen in about 2% of patients, which manifests as bruises. These usually go away after a few days.
Dizziness, seen in about 1% of patients. Some patients have a conscious or unconscious fear of needles which can produce dizziness and other symptoms of anxiety. Patients are usually treated lying down in order to reduce likelihood of fainting.
The survey concluded: "Acupuncture has adverse effects, like any therapeutic approach. If it is used according to established safety rules and carefully at appropriate anatomic regions, it is a safe treatment method."
Other injury
Other risks of injury from the insertion of acupuncture needles include:
Nerve injury, resulting from the accidental puncture of any nerve.
Brain damage or stroke, which is possible with very deep needling at the base of the skull.
Pneumothorax from deep needling into the lung.
Kidney damage from deep needling in the low back.
Haemopericardium, or puncture of the protective membrane surrounding the heart, which may occur with needling over a sternal foramen (a hole in the breastbone that occurs as the result of a congenital defect.)
Risk of terminating pregnancy with the use of certain acupuncture points that have been shown to stimulate the production of adrenocorticotropic hormone (ACTH) and oxytocin.
The chance of these is very small, and the risk can be further reduced through proper training of acupuncturists. Graduates of medical schools and (in the US) accredited acupuncture schools receive thorough instruction in proper technique so as to avoid these events. (Cf. Cheng, 1987)
Risks from omitting orthodox medical care
Receiving any form of alternative medical care without also receiving orthodox Western medical care can be inherently risky, since undiagnosed disease may go untreated and could worsen. For this reason many acupuncturists and doctors prefer to consider acupuncture a complementary therapy rather than an alternative therapy.
Critics also express concern that unethical or naive practitioners may induce patients to exhaust financial resources by pursuing ineffective treatment. However, many recent public health departments in modern countries have acknowledged the benefits of acupuncture by instituting regulations, ultimately raising the level of medicine practiced in these jurisdictions.
Safety compared with other treatments
Commenting on the relative safety of acupuncture compared with other treatments, the NIH consensus panel stated that "(a)dverse side effects of acupuncture are extremely low and often lower than conventional treatments." They also stated:
"the incidence of adverse effects is substantially lower than that of many drugs or other accepted medical procedures used for the same condition. For example, musculoskeletal conditions, such as fibromyalgia, myofascial pain, and tennis elbow... are conditions for which acupuncture may be beneficial. These painful conditions are often treated with, among other things, anti-inflammatory medications (aspirin, ibuprofen, etc.) or with steroid injections. Both medical interventions have a potential for deleterious side effects but are still widely used and are considered acceptable treatments."
In a Japanese survey of 55,291 acupuncture treatments given over five years by 73 acupuncturists, 99.8% of them were performed with no significant minor adverse effects and zero major adverse incidents (Hitoshi Yamashita, Bac, Hiroshi Tsukayama, BA, Yasuo Tanno, MD, PhD. Kazushi Nishijo, PhD, JAMA). Two combined studies in the UK of 66,229 acupuncture treatments yielded only 134 minor adverse events. (British Medical Journal 2001 Sep 1). The total of 121,520 treatments with acupuncture therapy were given with no major adverse incidents (for comparison, a single such event would have indicated a 0.0008% incidence).
Monday, April 28, 2008
What is acupuncture?
Acupuncture literally means 'needle piercing," the practice of inserting very fine needles into the skin to stimulate specific anatomic points in the body (called acupoints or acupuncture points) for therapeutic purposes. Along with the usual method of puncturing the skin with the fine needles, the practitioners of acupuncture also use heat, pressure, friction, suction, or impulses of electromagnetic energy to stimulate the points. The acupoints (acupuncture points) are stimulated to balance the movement of energy (qi) in the body to restore health. Acupuncture involves stimulating. In the past 40 years acupuncture has become a well-known, reasonably available treatment in developed and developing countries. Acupuncture is used to regulate or correct the flow of qi to restore health. To really understand how acupuncture works, it is necessary to become familiar with the basics of Chinese philosophy. The philosophies of the Dao or Tao, yin and yang, the eight principles, the three treasures and the five elements are all fundamental to traditional Chinese acupuncture and its specific role in helping to maintain good health and a person's well-being.
How Does Acupuncture Work
Historically, acupuncture points were believed to be holes that allow entry into channels. These holes provide us gateways to influence, redirect, increase, or decrease body's vital substance, qi, thus correcting many of the imbalances. Many studies and research were directed since to understand the mechanism of acupuncture. Effects of Acupuncture Acupuncture has been shown to stimulate the immune system. It also has affects the circulation, blood pressure, rhythm and stroke volume of the heart, secretion of the gastric acid, and production of red and white cells. It also stimulates the release of a variety of hormones that help body to respond to injury and stress. The Gate Control Theory of Pain According to this theory, pain signals must pass through a number of high-traffic "gates" as they move from the area of injury upward through the spinal cord into the brain. Like a road or highway, these nerves can handle only a limited number of nerve signals at one time. The pain signals travels very slowly. We can generate other signals which move faster. The faster signals crowd out the slower ones because of the limited capacity of the nerves. (Remember the time sitting in traffic near a construction zone, where the two lanes merge into one. The fast cars on the merging lanes go further and merge ahead of the slower ones, making it nearly impossible for the slow traffic on the lane to move forward. Now think about the pain signals are the slow ones sitting there waiting for an opening to move through. If one can produce enough fast signals, it can effectively crowd out the pain signals.) Acupuncture generates competing stimulus and effectively blocks the slow pain signals from reaching the brain. The result: we never "experience the pain". Electrical Theory of Pain The body continually generates tiny but detectable electrical discharges. This electrical field influences the growth, maturation, and functioning of some types of cells. It is known that acupuncture points are concentrated in regions of low electrical resistance. Studies have shown that there is a correlation between the electromagnetic fields in the body and the channels or meridians. So, this electrical theory of acupuncture suggests that acupuncture works by influencing the body's electromagnetic fields. Acupuncture points have certain electrical properties, and stimulating these points alters chemical neurotransmitters in the body.
Acupuncture Effective for Neck Pain
There is a fair amount of evidence that acupuncture can relieve chronic neck pain, according to a review of the most current scientific evidence on the effectiveness of acupuncture for neck pain.
Canadian researchers reported in the latest issue of The Cochrane Library (Issue 3, 2006) that acupuncture seems to work moderately well as an alternative to more traditional treatments for neck pain.
The researchers from McMaster University in Canada reviewed 10 trials that compared real acupuncture to fake or sham acupuncture, other sham or inactive treatments, or other active treatments such as massage therapy. The trials involved a total of 661 individuals with chronic neck pain lasting for at least three months.
Dr. Kien Trinh from McMaster University and colleagues found that, overall, people who received traditional Chinese acupuncture reported better pain relief immediately following acupuncture and in the short-term than those who received inactive acupuncture or other sham treatments. There were no serious side effects to acupuncture in the trials reviewed.
In a small study, people who received acupuncture had greater relief of pain than those who received massage therapy.
The research findings show that ideally there should be at least six or more acupuncture sessions for treating neck pain.
According to Reuters, between 26 percent and 71 percent of the adult population has suffered through at least one bout of neck pain or stiffness during their lifetime. For some, neck pain can last for months and negatively impact life and work.
Canadian researchers reported in the latest issue of The Cochrane Library (Issue 3, 2006) that acupuncture seems to work moderately well as an alternative to more traditional treatments for neck pain.
The researchers from McMaster University in Canada reviewed 10 trials that compared real acupuncture to fake or sham acupuncture, other sham or inactive treatments, or other active treatments such as massage therapy. The trials involved a total of 661 individuals with chronic neck pain lasting for at least three months.
Dr. Kien Trinh from McMaster University and colleagues found that, overall, people who received traditional Chinese acupuncture reported better pain relief immediately following acupuncture and in the short-term than those who received inactive acupuncture or other sham treatments. There were no serious side effects to acupuncture in the trials reviewed.
In a small study, people who received acupuncture had greater relief of pain than those who received massage therapy.
The research findings show that ideally there should be at least six or more acupuncture sessions for treating neck pain.
According to Reuters, between 26 percent and 71 percent of the adult population has suffered through at least one bout of neck pain or stiffness during their lifetime. For some, neck pain can last for months and negatively impact life and work.
Acupuncture Relieves Pain and Improves Function in Knee Osteoarthritis
Acupuncture provides pain relief and improves function for people with osteoarthritis of the knee and serves as an effective complement to standard care. This landmark study was funded by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), both components of the National Institutes of Health. The findings of the study--the longest and largest randomized, controlled phase III clinical trial of acupuncture ever conducted--were published in the December 21, 2004, issue of the Annals of Internal Medicine.1
The multi-site study team, including rheumatologists and licensed acupuncturists, enrolled 570 patients, aged 50 or older with osteoarthritis of the knee. Participants had significant pain in their knee the month before joining the study, but had never experienced acupuncture, had not had knee surgery in the previous 6 months, and had not used steroid or similar injections. Participants were randomly assigned to receive one of three treatments: acupuncture, sham acupuncture, or participation in a control group that followed the Arthritis Foundation's self-help course for managing their condition. Patients continued to receive standard medical care from their primary physicians, including anti-inflammatory medications, such as COX-2 selective inhibitors, non-steroidal anti-inflammatory drugs, and opioid pain relievers.
"For the first time, a clinical trial with sufficient rigor, size, and duration has shown that acupuncture reduces the pain and functional impairment of osteoarthritis of the knee," said Stephen E. Straus, M.D., NCCAM Director. "These results also indicate that acupuncture can serve as an effective addition to a standard regimen of care and improve quality of life for knee osteoarthritis sufferers. NCCAM has been building a portfolio of basic and clinical research that is now revealing the power and promise of applying stringent research methods to ancient practices like acupuncture."
"More than 20 million Americans have osteoarthritis. This disease is one of the most frequent causes of physical disability among adults," said Stephen I. Katz, M.D., Ph.D., NIAMS Director. "Thus, seeking an effective means of decreasing osteoarthritis pain and increasing function is of critical importance."
During the course of the study, led by Brian M. Berman, M.D., Director of the Center for Integrative Medicine and Professor of Family Medicine at the University of Maryland School of Medicine, Baltimore, Maryland, 190 patients received true acupuncture and 191 patients received sham acupuncture for 24 treatment sessions over 26 weeks. Sham acupuncture is a procedure designed to prevent patients from being able to detect if needles are actually inserted at treatment points. In both the sham and true acupuncture procedures, a screen prevented patients from seeing the knee treatment area and learning which treatment they received. In the education control group, 189 participants attended six, 2-hour group sessions over 12 weeks based on the Arthritis Foundation's Arthritis Self-Help Course, a proven, effective model.
On joining the study, patients' pain and knee function were assessed using standard arthritis research survey instruments and measurement tools, such as the Western Ontario McMasters Osteoarthritis Index (WOMAC). Patients' progress was assessed at 4, 8, 14, and 26 weeks. By week 8, participants receiving acupuncture were showing a significant increase in function and by week 14 a significant decrease in pain, compared with the sham and control groups. These results, shown by declining scores on the WOMAC index, held through week 26. Overall, those who received acupuncture had a 40 percent decrease in pain and a nearly 40 percent improvement in function compared to baseline assessments.
"This trial, which builds upon our previous NCCAM-funded research, establishes that acupuncture is an effective complement to conventional arthritis treatment and can be successfully employed as part of a multidisciplinary approach to treating the symptoms of osteoarthritis," said Dr. Berman.
Acupuncture--the practice of inserting thin needles into specific body points to improve health and well-being--originated in China more than 2,000 years ago. In 2002, acupuncture was used by an estimated 2.1 million U.S. adults, according to the Centers for Disease Control and Prevention's 2002 National Health Interview Survey.2 The acupuncture technique that has been most studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation. In recent years, scientific inquiry has begun to shed more light on acupuncture's possible mechanisms and potential benefits, especially in treating painful conditions such as arthritis.
The multi-site study team, including rheumatologists and licensed acupuncturists, enrolled 570 patients, aged 50 or older with osteoarthritis of the knee. Participants had significant pain in their knee the month before joining the study, but had never experienced acupuncture, had not had knee surgery in the previous 6 months, and had not used steroid or similar injections. Participants were randomly assigned to receive one of three treatments: acupuncture, sham acupuncture, or participation in a control group that followed the Arthritis Foundation's self-help course for managing their condition. Patients continued to receive standard medical care from their primary physicians, including anti-inflammatory medications, such as COX-2 selective inhibitors, non-steroidal anti-inflammatory drugs, and opioid pain relievers.
"For the first time, a clinical trial with sufficient rigor, size, and duration has shown that acupuncture reduces the pain and functional impairment of osteoarthritis of the knee," said Stephen E. Straus, M.D., NCCAM Director. "These results also indicate that acupuncture can serve as an effective addition to a standard regimen of care and improve quality of life for knee osteoarthritis sufferers. NCCAM has been building a portfolio of basic and clinical research that is now revealing the power and promise of applying stringent research methods to ancient practices like acupuncture."
"More than 20 million Americans have osteoarthritis. This disease is one of the most frequent causes of physical disability among adults," said Stephen I. Katz, M.D., Ph.D., NIAMS Director. "Thus, seeking an effective means of decreasing osteoarthritis pain and increasing function is of critical importance."
During the course of the study, led by Brian M. Berman, M.D., Director of the Center for Integrative Medicine and Professor of Family Medicine at the University of Maryland School of Medicine, Baltimore, Maryland, 190 patients received true acupuncture and 191 patients received sham acupuncture for 24 treatment sessions over 26 weeks. Sham acupuncture is a procedure designed to prevent patients from being able to detect if needles are actually inserted at treatment points. In both the sham and true acupuncture procedures, a screen prevented patients from seeing the knee treatment area and learning which treatment they received. In the education control group, 189 participants attended six, 2-hour group sessions over 12 weeks based on the Arthritis Foundation's Arthritis Self-Help Course, a proven, effective model.
On joining the study, patients' pain and knee function were assessed using standard arthritis research survey instruments and measurement tools, such as the Western Ontario McMasters Osteoarthritis Index (WOMAC). Patients' progress was assessed at 4, 8, 14, and 26 weeks. By week 8, participants receiving acupuncture were showing a significant increase in function and by week 14 a significant decrease in pain, compared with the sham and control groups. These results, shown by declining scores on the WOMAC index, held through week 26. Overall, those who received acupuncture had a 40 percent decrease in pain and a nearly 40 percent improvement in function compared to baseline assessments.
"This trial, which builds upon our previous NCCAM-funded research, establishes that acupuncture is an effective complement to conventional arthritis treatment and can be successfully employed as part of a multidisciplinary approach to treating the symptoms of osteoarthritis," said Dr. Berman.
Acupuncture--the practice of inserting thin needles into specific body points to improve health and well-being--originated in China more than 2,000 years ago. In 2002, acupuncture was used by an estimated 2.1 million U.S. adults, according to the Centers for Disease Control and Prevention's 2002 National Health Interview Survey.2 The acupuncture technique that has been most studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation. In recent years, scientific inquiry has begun to shed more light on acupuncture's possible mechanisms and potential benefits, especially in treating painful conditions such as arthritis.
Acupuncture for Fibromyalgia
The Centers for Medicare and Medicaid Services (CMS) commissioned an expedited review of the literature on acupuncture for fibromyalgia from the Agency for Healthcare Research and Quality (AHRQ). In order to expedite the review, CMS requested that the review be based on systematic reviews that are published by other groups. Therefore this review contains: a) A review of recent (1995 to present) systematic reviews on the use of acupuncture for fibromyalgia, updated with any RCTs published since the date of the last systematic review (2000 to present). b) Information available in the literature on training for persons performing this therapy and the number of physicians certified to perform this therapy.
What Disorders Can Acupuncture Treat And How Does It Work
How did acupuncture start?
During a visit to China in 1978, cardiologist Doctor Isadore Rosenfeld witnessed open-heart surgery on a patient, anaesthetised only with acupuncture. A major operation and the patient was awake! Nothing like it had ever been seen before in the west.
But acupuncture is over 5000 years old. There is evidence that it was practiced by the ancient Egyptians. South African tribesmen scratched their bodies to cure disease and the Eskimos used a simple form of acupuncture. In ancient China the Yellow Emperor's bible on internal medicine talks about the importance of acupuncture for curing disease and restoring health.
Today, in China and Taiwan there are over 232,000 traditional Chinese medical doctors practicing acupuncture. In America there are more than 8000 qualified acupuncturists, 16 acupuncture schools and 2 medical schools teaching acupuncture. As a treatment it's accepted and practiced worldwide.
What ailments can acupuncture treat?
Many people assume that acupuncture is used as a simple pain control technique. A technique where needles are inserted to interrupt the nerve pathways that send pain messages to the brain. But acupuncture is much more than this. It's designed to treat any malady and works to balance the energy of your entire body.
Based on clinical experience, it's known that acupuncture can treat a variety of respiratory, eye and mouth, gastro-intestinal, neurological and muscular disorders. It's especially effective on headaches, migraine and back pain.
Acupuncture is also used to stop smoking, lose weight, lower blood pressure, relive constipation, anxiety, insomnia, allergies, asthma and alleviate skin disorders.
How can it treat all these ailments? It works by 'unblocking' and balancing your energy 'circuits'. And unlike conventional drugs, there are only beneficial side-effects such as sleeping better, more energy, deeper breathing and many other bonuses.
How does acupuncture work?
Acupuncture means 'to puncture with a needle'. Fine, flexible needles, about the diameter of a human hair, are inserted into points along the principal meridians of your body.
Your body has a network of energy channels or 'meridians' in which your 'ki' flows. Each meridian is associated with a physiological system and internal organ.
There are 12 principal meridians that run the length of your body and each one has more than 350 acupuncture points. Acupuncture points are specific locations along the meridians. Inserting a needle into a point will 'unblock' or stimulate the energy flow through the meridian in a very predictable and measured way.
What happens during a treatment session?
Acupucture is all part of the philosophy and practice of TCM or Traditional Chinese Medicine, which uses an intricate system of pulse and tongue diagnosis.
A qualified acupuncturist will also check the 'palpation' of the acupuncture points or meridians, your medical history and any other signs or symptoms of disorder.
The treatment is painless and insertion of the needles can feel like an insect bite or tiny prick. If you are sensitive you will feel warmth or energy flow and is often described as a 'buzz'.
Sometimes moxibustion is used to increase the heat effect at the insertion point. A Chinese herb, 'Moxa', is placed on the needle and lit. This can stimulate the blood flow as well as the 'chi'.
Is acupuncture safe?
Nobody can predict the changes that will occur. Your body will do what it needs to do to heal itself. But the healing process starts with skilful diagnosis and the correct stimulation of precise acupuncture points.
Acupuncture will often compliment traditional western medicine, and in the hands of a trained and properly qualified acupuncturist, you are perfectly safe. And for many people it is enjoyable too.
Although the Chinese may have enjoyed the benefits of acupuncture for many centuries, the legacy of discoveries by men such as Dr Isadore Rosenfeld means we can all benefit from this wonderful treatment.
During a visit to China in 1978, cardiologist Doctor Isadore Rosenfeld witnessed open-heart surgery on a patient, anaesthetised only with acupuncture. A major operation and the patient was awake! Nothing like it had ever been seen before in the west.
But acupuncture is over 5000 years old. There is evidence that it was practiced by the ancient Egyptians. South African tribesmen scratched their bodies to cure disease and the Eskimos used a simple form of acupuncture. In ancient China the Yellow Emperor's bible on internal medicine talks about the importance of acupuncture for curing disease and restoring health.
Today, in China and Taiwan there are over 232,000 traditional Chinese medical doctors practicing acupuncture. In America there are more than 8000 qualified acupuncturists, 16 acupuncture schools and 2 medical schools teaching acupuncture. As a treatment it's accepted and practiced worldwide.
What ailments can acupuncture treat?
Many people assume that acupuncture is used as a simple pain control technique. A technique where needles are inserted to interrupt the nerve pathways that send pain messages to the brain. But acupuncture is much more than this. It's designed to treat any malady and works to balance the energy of your entire body.
Based on clinical experience, it's known that acupuncture can treat a variety of respiratory, eye and mouth, gastro-intestinal, neurological and muscular disorders. It's especially effective on headaches, migraine and back pain.
Acupuncture is also used to stop smoking, lose weight, lower blood pressure, relive constipation, anxiety, insomnia, allergies, asthma and alleviate skin disorders.
How can it treat all these ailments? It works by 'unblocking' and balancing your energy 'circuits'. And unlike conventional drugs, there are only beneficial side-effects such as sleeping better, more energy, deeper breathing and many other bonuses.
How does acupuncture work?
Acupuncture means 'to puncture with a needle'. Fine, flexible needles, about the diameter of a human hair, are inserted into points along the principal meridians of your body.
Your body has a network of energy channels or 'meridians' in which your 'ki' flows. Each meridian is associated with a physiological system and internal organ.
There are 12 principal meridians that run the length of your body and each one has more than 350 acupuncture points. Acupuncture points are specific locations along the meridians. Inserting a needle into a point will 'unblock' or stimulate the energy flow through the meridian in a very predictable and measured way.
What happens during a treatment session?
Acupucture is all part of the philosophy and practice of TCM or Traditional Chinese Medicine, which uses an intricate system of pulse and tongue diagnosis.
A qualified acupuncturist will also check the 'palpation' of the acupuncture points or meridians, your medical history and any other signs or symptoms of disorder.
The treatment is painless and insertion of the needles can feel like an insect bite or tiny prick. If you are sensitive you will feel warmth or energy flow and is often described as a 'buzz'.
Sometimes moxibustion is used to increase the heat effect at the insertion point. A Chinese herb, 'Moxa', is placed on the needle and lit. This can stimulate the blood flow as well as the 'chi'.
Is acupuncture safe?
Nobody can predict the changes that will occur. Your body will do what it needs to do to heal itself. But the healing process starts with skilful diagnosis and the correct stimulation of precise acupuncture points.
Acupuncture will often compliment traditional western medicine, and in the hands of a trained and properly qualified acupuncturist, you are perfectly safe. And for many people it is enjoyable too.
Although the Chinese may have enjoyed the benefits of acupuncture for many centuries, the legacy of discoveries by men such as Dr Isadore Rosenfeld means we can all benefit from this wonderful treatment.
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