Acupuncture Facts
• Acupuncture originated in China more than 2,000 years ago, making it one of the oldest and most commonly used medical procedures in the world.
• It is important to inform all of your health care providers about any treatment that you are using or considering, including acupuncture. Ask about the treatment procedures that will be used and their likelihood of success for your condition or disease.
• Be an informed consumer and find out what scientific studies have been done on the effectiveness of acupuncture for your health condition.
• If you decide to use acupuncture, choose the practitioner with care. Also check with your insurer to see if the services will be covered.
What is acupuncture?
Acupuncture is one of the oldest, most commonly used medical procedures in the world. Originating in China more than 2,000 years ago, acupuncture began to become better known in the United States in 1971, when New York Times reporter James Reston wrote about how doctors in China used needles to ease his pain after surgery.
The term acupuncture describes a family of procedures involving stimulation of anatomical points on the body by a variety of techniques. American practices of acupuncture incorporate medical traditions from China, Japan, Korea, and other countries. 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.
How widely is acupuncture used in the United States?
In the past two decades, acupuncture has grown in popularity in the United States. The report from a Consensus Development Conference on Acupuncture held at the National Institutes of Health (NIH) in 1997 stated that acupuncture is being "widely" practiced - by thousands of physicians, dentists, acupuncturists, and other practitioners - for relief or prevention of pain and for various other health conditions. According to the 2002 National Health Interview Survey - the largest and most comprehensive survey of complementary and alternative medicine (CAM) use by American adults to date - an estimated 8.2 million U.S. adults had ever used acupuncture, and an estimated 2.1 million U.S. adults had used acupuncture in the previous year.
How does acupuncture work?
Acupuncture is one of the key components of the system of traditional Chinese medicine (TCM). In the TCM system of medicine, the body is seen as a delicate balance of two opposing and inseparable forces: yin and yang. Yin represents cold, slow, or passive aspects of the person, while yang represents hot, excited, or active aspects. Among the major assumptions in TCM are that health is achieved by maintaining the body in a "balanced state" and that disease is due to an internal imbalance of yin and yang. This imbalance leads to blockage in the flow of qi (vital energy, pronounced “chi”) along pathways known as channels or meridians. It is believed that there are 12 main meridians and 8 secondary meridians and that there are more than 2,000 acupuncture points on the human body that connect with them.
The Western medical explanation of acupuncture incorporates modern concepts of neuroscience. According to the National Institutes of Health, researchers are studying at least three possible explanations for how acupuncture works:
• Opioid release. During acupuncture, endorphins that are part of your body's natural pain-control system may be released into your central nervous system — your brain and spinal cord. This reduces pain much like taking a pain medication.
• Spinal cord stimulation. Acupuncture may stimulate the nerves in your spinal cord to release pain-suppressing neurotransmitters. This has sometimes been called the "gate theory."
• Blood flow changes. Acupuncture needles may increase the amount of blood flow in the area around the needle. The increased blood flow may supply additional nutrients or remove toxic substances, or both, promoting healing.
It is proposed that acupuncture produces its effects through regulating the nervous system, thus aiding the activity of pain-killing biochemicals such as endorphins and immune system cells at specific sites in the body. In addition, studies have shown that acupuncture may alter brain chemistry by changing the release of neurotransmitters and neurohormones and, thus, affecting the parts of the central nervous system related to sensation and involuntary body functions, such as immune reactions and processes that regulate a person's blood pressure, blood flow, and body temperature.
Who can benefit from acupuncture?
Acupuncture seems to be useful as a stand-alone treatment for some conditions, but it is also increasingly being used in conjunction with more conventional Western medical treatments, For example, doctors may combine acupuncture and drugs to control pain during and after surgery. Acupuncture may offer symptomatic relief for a variety of diseases and conditions including low back pain, headaches, migraines and osteoarthritis. In a 2006 Mayo clinical study, acupuncture significantly improved symptoms of fibromyalgia. It also appears to offer relief for chronic menstrual cramps and tennis elbow. A recent landmark study funded by the NIH showed that acupuncture provides pain relief, improves function for people with osteoarthritis of the knee, and serves as an effective complement to standard care. There are other situations such as addiction, stroke rehabilitation, headache, myofascial pain, osteoarthritis, low-back pain, carpal tunnel syndrome, and asthma in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Around the world, the use of acupuncture is being studied for many medical conditions and diseases.
What does acupuncture feel like?
Acupuncture needles are metallic, solid, and hair-thin. People experience acupuncture differently, but most feel no or minimal pain as the needles are inserted. Some people are energized by treatment, while others feel relaxed. Improper needle placement, movement of the patient, or a defect in the needle can cause soreness and pain during treatment. This is why it is important to seek treatment from a qualified acupuncture practitioner.
Is acupuncture safe?
The U.S. Food and Drug Administration (FDA) approved acupuncture needles for use by licensed practitioners in 1996. The FDA requires that sterile, nontoxic needles be used and that they be labeled for single use by qualified practitioners only.
Relatively few complications from the use of acupuncture have been reported to the FDA in light of the millions of people treated each year and the number of acupuncture needles used. Still, complications have resulted from inadequate sterilization of needles and from improper delivery of treatments. Practitioners should use a new set of disposable needles taken from a sealed package for each patient and should swab treatment sites with alcohol or another disinfectant before inserting needles. When not delivered properly, acupuncture can cause serious adverse effects, including infections and punctured organs.
Promising results have emerged, as mentioned above, showing efficacy of acupuncture, in adult postoperative and chemotherapy nausea and vomiting in postoperative dental pain and osteoarthritis of the knee. Further research is likely to uncover additional areas where acupuncture interventions will be useful.
How to choose an acupuncturist practitioner?
Health care practitioners can be a resource for referral to acupuncturists. More medical doctors, including neurologists, anesthesiologists, and specialists in physical medicine, are becoming trained in acupuncture.
Credentials?
In the state of New York, an acupuncture practitioner must be licensed. About 40 states have established training standards for acupuncture certification, but states have varied requirements for obtaining a license to practice acupuncture.17 Although proper credentials do not ensure competency, they do indicate that the practitioner has met certain standards to treat patients through the use of acupuncture. Both physicians and non-physicians can become licensed.
Do not rely on a diagnosis of disease by an acupuncture practitioner who is not a physician.
Non-physician acupuncturists rely on diagnoses made according to Traditional Chinese Medical. These are different from the diagnoses your physician makes. If you have a medical problem and do not have a diagnosis, see your doctor for a medical diagnosis. You may wish to ask your doctor whether acupuncture might help and if he or she would be willing to speak briefly to your acupuncturist about your problem.
How much will acupuncture cost?
A practitioner can inform you about the estimated number of treatments needed and how much each will cost. If this information is not provided, you can ask for it. Treatment may take place over a few days or for several weeks or more. Physician acupuncturists typically charge more than non-physician practitioners, so inquire of your insurance company about your coverage, since you may prefer to have a physician acupuncturist.
Will it be covered by my insurance?
Acupuncture is one of the Complementary and Alternative medical therapies that are sometimes partially covered by insurance. However, you should check with your insurer before you start treatment to see whether acupuncture will be covered for your condition and, if so, to what extent. Some insurance plans require preauthorization for acupuncture.
What should I expect during my first visit?
During your first office visit, the practitioner may ask you at length about your health condition, lifestyle, and behavior. The practitioner will want to obtain a complete picture of your treatment needs and behaviors that may contribute to your condition. Inform the acupuncturist about all treatments or medications you are taking, including supplements, and all medical conditions you have. Most often, acupuncture is not performed at the first visit, as it is an information gathering session for both you and your doctor. A schedule of acupuncture treatments will be arranged before you leave the office on the first visit.
References
1. Culliton PD. Current utilization of acupuncture by United States patients. Abstract presented at: National Institutes of Health Consensus Development Conference on Acupuncture; 1997.
2. Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002. CDC Advance Data Report #343. 2004.
3. American Academy of Medical Acupuncture. Doctor, What's This Acupuncture All About? A Brief Explanation. American Academy of Medical Acupuncture Web site. Accessed at www.medicalacupuncture.org/acu_info/articles/aboutacupuncture.html on December 14, 2004.
4. Lao L. Safety issues in acupuncture. Journal of Alternative and Complementary Medicine. 1996; 2(1):27-31.
5. U.S. Food and Drug Administration. Acupuncture needles no longer investigational. FDA Consumer. 1996; 30(5). Also available at: www.fda.gov/fdac/departs/596_upd.html.
6. Lytle CD. An Overview of Acupuncture. Rockville, MD: U.S. Food and Drug Administration, Center for Devices and Radiological Health; 1993.
7. Berman BM, Lao L, Langenberg P, et al. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Annals of Internal Medicine. 2004; 141(12):901-910.
8. National Institutes of Health Consensus Panel. Acupuncture: National Institutes of Health Consensus Development Statement. National Institutes of Health Web site. Accessed at odp.od.nih.gov/consensus/cons/107/107_statement.htm on December 14, 2004.
9. Eskinazi DP. NIH Technology Assessment Workshop on Alternative Medicine: Acupuncture. Gaithersburg, Maryland, USA, April 21-22, 1994. Journal of Alternative and Complementary Medicine. 1996; 2(1):1-256.
10. Tang NM, Dong HW, Wang XM, et al. Cholecystokinin antisense RNA increases the analgesic effect induced by electroacupuncture or low dose morphine: conversion of low responder rats into high responders. Pain. 1997; 71(1):71-80.
11. Cheng XD, Wu GC, He QZ, et al. Effect of electroacupuncture on the activities of tyrosine protein kinase in subcellular fractions of activated T lymphocytes from the traumatized rats. Acupuncture and Electro-Therapeutics Research. 1998; 23(3-4):161-170.
12. Chen LB, Li SX. The effects of electrical acupuncture of Neiguan on the PO2 of the border zone between ischemic and non-ischemic myocardium in dogs. Journal of Traditional Chinese Medicine. 1983; 3(2):83-88.
13. Lee HS, Kim JY. Effects of acupuncture on blood pressure and plasma renin activity in two-kidney one clip Goldblatt hypertensive rats. American Journal of Chinese Medicine. 1994; 22(3-4):215-219.
14. Okada K, Oshima M, Kawakita K. Examination of the afferent fiber responsible for the suppression of jaw-opening reflex in heat, cold, and manual acupuncture stimulation in rats. Brain Research. 1996; 740(1-2):201-207.
15. Takeshige C. Mechanism of acupuncture analgesia based on animal experiments. In: Pomerantz B, Stux G, eds. Scientific Bases of Acupuncture. Berlin, Germany: Springer-Verlag; 1989.
16. Lee BY, LaRiccia PJ, Newberg AB. Acupuncture in theory and practice. Hospital Physician. 2004; 40:11-18.
17. White House Commission on Complementary and Alternative Medicine Policy: Final Report. March 2002. White House Commission on Complementary and Alternative Medicine Policy Web site. Accessed at www.whccamp.hhs.gov/finalreport.html on December 14, 2004.