Acupuncture

Abstract

Many patients with chronic pain turn to alternative, complementary therapy as part of their pain management. Acupuncture has been gaining legitimacy for decades and was approved as a medical therapy in the United States in the 1990s. Numerous studies have assessed acupuncture’s therapeutic potential for a variety of diseases and disorders, with mixed results. While there is positive evidence of acupuncture’s beneficial effects for knee and low back pain, as well as migraines, research also shows the placebo effect may play an equally important role in the efficacy of acupuncture. Acupuncture is based on the principal of applied pressure through the insertion of thin needles into specific points of the body serving as channels of connection to specific organs. The ideology of acupuncture defines health as the interconnection of wellness, not just the absence of disease. Acupuncture aims to restore and align one’s qi, or vital energy, by resolving blockages or excessive buildup of qi in the body. One of the oldest therapies in traditional Chinese medicine, this nonpharmacological option has been studied for the treatment of multiple diseases and symptoms, including insomnia, pain, allergies, hot flashes, respiratory issues, mood disorders, tobacco use, and GI symptoms. In recent years, acupuncture has become more popular and moved out of the category of fringe treatments. Acupuncture is now an in-office procedure covered by many insurance providers. During the procedure, a practitioner inserts 5 to 20 single-use, stainless steel, flexible needles ranging from 10 mm to 100 mm into identified acupuncture points, where they remain for 10 to 20 minutes while the patient is relaxed and lying down. Quick introduction of the needle by a skillful practitioner minimizes any anticipated pain. The mechanisms of acupuncture’s action and efficacy are still under study. Proposed explanations include vagal nerve stimulation that alleviates chronic inflammation, hormonal changes influenced by needle insertion, and immunomodulation caused by pressure on major neural bundles. Another potential mechanism is that analgesia may result from spinal or supraspinal release of natural opioids. Many high-quality randomized controlled trials have addressed acupuncture’s effectiveness in the treatment of acute or chronic back pain, knee pain, and headaches. Multiple studies show both acupuncture treatment and simulated therapies provide superior pain relief compared with no treatment at all. A 2020 Cochrane Database Systematic Review meta-analysis reviewed 33 randomized controlled trials of acupuncture use for chronic lower back pain in adults. The studies compared acupuncture with sham intervention, usual care, or no treatment in 8,270 participants. The review authors determined that while acupuncture was more effective than no treatment in improving pain and function, acupuncture did not play a more clinically meaningful role than simulated intervention in relieving pain or improving quality of life. A 2006 randomized controlled trial in Annals of Internal Medicine assessed the efficacy and safety of acupuncture compared with sham acupuncture and conservative therapy. More than 1,000 patients with chronic pain for at least 6 months due to osteoarthritis of the knee were allocated up to 6 physiotherapy sessions and as-needed NSAIDs, plus either 10 sessions of acupuncture, 10 sessions of sham acupuncture, or 10 physician visits over the course of 6 weeks. Researchers found success rates of 53.1% for acupuncture, 51.0% for sham acupuncture, and 29.1% for conservative therapy, with no significant difference between acupuncture and sham acupuncture. A randomized controlled trial published in JAMA in 2005 investigated the effectiveness of acupuncture, sham acupuncture, or waiting list control in 302 patients with migraine. No significant difference was detected between the acupuncture (51% reduction in headache days) and the sham acupuncture (53% reduction in headache days) groups in reducing migraine headaches, but researchers did find a significant difference compared with the control (15% reduction). Acupuncture is considered generally safe when performed by an experienced, well-trained practitioner. As a complementary therapy, acupuncture offers an overall positive response with limited adverse effects and a nonpharmacologic treatment option to address pain. Consider letting your patients know that believing in the efficacy of acupuncture is just as important to treatment as the therapy itself.