Acupuncture

Why Acupuncture?

• Lack of knowledge about basis for and effectiveness of it

• Skepticism

• Interested by fact that a physician in my primary care office practices it

Background

• Has been widely used in China for at least 2,500 years

• Yin (cold, slow, passive) and Yang (hot, excited, active) must be in balance

• An imbalance of Yin and Yang leads to a blockage in the flow of Qi (vital energy) along meridians

• There are 12 main and 8 secondary meridians

• Over 2000 acupuncture points connect these meridians

• Acupuncture in the US

  • Was relatively uncommon until President Nixon visited China in 1972

  • American acupuncture incorporates medical traditions from China, Japan and Korea

  • Needle use for acupuncture approved by FDA in 1996

  • NIH consensus statement published in 1997

  • >1 million patients make >5 million visits for acupuncture in the US each year

• How its Done

  • Most studied mechanism is use of thin, solid, metallic needles manipulated manually

  • Can also use sound waves, electrical impulses, moxibustion, pressure, heat, lasers

• NIH Consensus Statement published in 1996

  • Many studies published provide equivocal results b/c of study design, sample size, other factors

  • Research complicated by inherent difficulties in use of appropriate controls such as placebo and sham

    • Disagreement on needle placement

    • Many studies, esp pain studies, show intermediate effects between placebo and true acupuncture, some show similar effects to true acupuncture

    • Needle placement in any position elicits biological response that complicates interpretation of studies

  • Promising results have emerged, ie post-op pain, chemotherapy n/v,

  • Less convincing but potential benefit in addiction, stroke rehab, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, asthma

Biologic Effects

• Both local and distant responses mediated mainly by sensory neurons to many structures within CNS

• Opioid peptide release

• Analgesic effects reversed by naloxone

• Acitvation of hypothalamus, pituitary gland à systemic effects

• Alteration in secretion of neurotransmitters

• Changes in regulation of blood flow, centrally & peripherally

• Alterations in immune function

Important Factors Contributing to Efficacy

• Quality of relationship & degree of trust between clinician and patient

• Expectations of patient regarding treatment

• Compatibility of backgrounds and belief systems of clinician and patient

Acupuncture & Headaches

• RCT in British Medical Journal, 2004

• 401 patients randomized to acupuncture vs medical treatment

• Acupuncture group had 22 fewer days of HA over 1 yr, used 15% less medication, had 25% fewer doctor visits 12 months out

• Headache score (primary outcome) was lower in acupuncture group than control group

  • Acupuncture: 16.2, SD 13.7 n=161, 34% reduction

  • Control: 22.3, SD 17.0, n=140, 16% reduction

References:

Goroll, Allan H & Mulley, Albert G. Jr. (2006). Primary Care Medicine: Office

Evaluation and Management of the Adult Patient, 5th Edition. Philadephia, PA:

Lippincott Williams & Wilkins.

Vickers, Andrew J et. al. (2004). Acupuncture for chronic headache in primary care:

Large, pragmatic, randomized trial. British Medical Journal. 328:744

Acupuncture. NIH Consensus Statement Online 1997 Nov 3-5; 15(5):1-34

Category: Surgery Notes