Acupuncture - uses

Written by: 
Richard Thomas, medical writer

When is acupuncture commonly used and what evidence is there to support this?

Practitioners of acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. - the ancient Chinese art of healing by inserting very fine needles into the body at specific points and stimulating them to promote the body's self-healing processes - have claimed success in treating a very wide range of ailments, from the minor to the life-threatening.

For more background, see Acupuncture - what is it?

There have been claims that more than 100 ailments can be helped by acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. - but much of the evidence to date is anecdotal (based on individual reports rather than clinical trials) and good medical research has lagged behind many of these claims.

Research

Nevertheless there is a steadily growing body of clinical evidence that acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. is effective in an increasing number of conditions, including many types of pain, fibromyalgia, osteoarthritisA disease mainly of the large joints of the body, as a result of wear and tear of the surface cartilage., nausea and vomiting and indigestionDiscomfort after eating..1

A 20th-century variation of acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. using points on the ear, known as auricular therapy (or sometimes auriculotherapy or auricular acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points.), might also be effective in treating some drug and alcohol addictions.2,3

Traditional and medical acupuncture

Acupuncture and the related practice of acupressureA complementary therapy derived from acupuncture, which uses finger pressure rather than the fine sterile needles used in acupuncture. - applying pressure, usually with the fingers or thumbs, to specific points on the body - are both part of the centuries-old system of healing today known as Traditional Chinese Medicine (TCM).

Read more about acupressure.

Acupuncture as traditionally practised in China is distinct from so-called 'medical' acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. - acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. practised by Western doctors without belief in the traditional Chinese philosophy behind it.

This Western form of acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. was largely developed in France at the start of the 20th century and is now widely practised by medically qualified practitioners in many countries, including China itself.

In most of these countries, acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. may only be carried out by medically qualified practitioners.

Most clinical research is into the use of medical acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points..

Read more on the background, history and theory of acupuncture.

Medical acceptance

More than 1,000 clinical trials of medical acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. have been performed. The results of these led the US National Institutes of Health (NIH) in 1997 to approve the use of acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. in mainstream healthcare for various types of pain relief, including chronicA disease of long duration generally involving slow changes. (long-term) pain and osteoarthritisA disease mainly of the large joints of the body, as a result of wear and tear of the surface cartilage., and for nausea and vomiting, including that resulting from cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. treatments such as chemotherapy.1

In May 2009 the British National Institute for Health and Clinical Excellence (NICE) announced that it supported acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points., among other complementary therapies such as chiropractic, over drugs for the treatment of back pain.4

The World Health Organization (WHO) has not officially sanctioned the use of acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points., and has called for more research into it. Its 2008 Beijing Declaration, however, placed traditional medicine at the centre of its new global strategy on public health, and cited acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. as an example of a traditional therapy having a potentially major part to play in future world healthcare.5

Efficacy

So far the strongest evidence for the benefit of acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. has been in the following conditions and forms of relief.

Pain relief

A large number of clinical trials have shown good evidence that acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. is effective in treating pain, especially long-lasting back pain, neck pain, pain after an operation, including after dental procedures, and during and after endoscopyExamination of the inside of the body using a tube equipped with a light source and either a small camera or an optical system. (the insertion of a small investigative camera into the intestines or upper digestive tract).6-13

A 2007 German study, for example, found that even so-called 'sham' acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. - needling applied not according to accepted practice (usually used as a control treatment in formal acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. trials) - improved pain in the lower back in some patients for at least six months. Its effectiveness was almost twice that of conventional pain therapy.6

Treatment patterns in acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. vary according to both patient and practitioner. For the treatment of pain, two 30-minute sessions a week over a period of between three weeks and three months is typical.

Osteoarthritis

Acupuncture has been shown to be effective in treating pain resulting from osteoarthritisA disease mainly of the large joints of the body, as a result of wear and tear of the surface cartilage., particularly in the knees and hips, although results have been variable - again this seems to depend very much on individual treatment regimes.14-1

Where acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. has been demonstrated to be effective, people generally received between six and 15 sessions over a period of 6 - 12 weeks.

Fibromyalgia

Several studies have suggested that acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. may help with pain relief in fibromyalgia as well as with such associated symptoms as fatigue and anxiety.18-20

Nausea and vomiting

Acupuncture at a specific point on the wrist known as pericardiumThe sac surrounding the heart. 6 (P6) has been shown not only to reduce nausea and vomiting after chemotherapyThe use of chemical substances to treat disease, particularly cancer. and surgery but also to be as effective as anti-nausea drugs.22-25 See also acupressure.

Indigestion (dyspepsia)

A clinical trial has shown that acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. can relieve the symptoms of indigestionDiscomfort after eating. and heartburn during pregnancy.26

Summary

Studies have shown that acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. treatment is usually safe and rarely has a negative effect: it has not made a condition worse. Nevertheless, while some trials have shown that acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. can bring strong benefits in treating certain conditions, more trials have shown either only small improvements or no clear benefits from acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points..

Clinical research is complicated due to the difficulty of providing a true placebo treatment as a control, which makes interpretation of the results of trials using 'sham' acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. problematic. In addition, many trials that have compared acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. with conventional treatment have found a stronger effect of the conventional treatment.

The NIH stated in 2009 that it supports the use of acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. for conditions such as chronicA disease of long duration generally involving slow changes. back pain, although it considers that the evidence is not conclusive either way for the majority of the ailments acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. claims to help.1

Moreover it concluded that in situations such as addictions, stroke rehabilitationThe treatment of a person with an illness or disability to improve their function and health., headache, menstrual cramps, tennis elbow, myofascial pain, carpal tunnel syndrome and asthma 'acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management programme', and added: 'Further research is likely to uncover additional areas where acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. interventions will be useful.'

In summary, acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. has been proven to work in some clinical situations, and may be proven to work in many more. Overall, however, there is not yet convincing scientific evidence in support of the widespread use of acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. and much more research is needed.

References: 
  1. 'Acupuncture.' NIH Consensus Statement. Anonymous. 11 March 1997; 15(5): 1-34.2.
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  4. 'Low back pain: early management of persistent non-specificHaving a general effect. low back pain.' Full guideline. NHS National Insitute for Health and Clinical Excellence. May 2009. Link
  5. 'Address at the WHO Congress on Traditional Medicine.' Dr Margaret Chan, Director-General of the World Health Organization. 7 Nov 2008. Link
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  12. Sung YF, Kutner MH, Cerine FC et al. 'Comparison of the effects of acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. and codeine on postoperative dental pain.' Anesth Analg Cur Res. 1977; 56(4): 473-478.
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