More than 3 million Americans receive acupuncture treatments each year, to relieve chronic pain, to reduce nausea and vomiting after surgery or chemotherapy, or for other conditions. But many doctors, insurers and potential patients have remained skeptical of the practice, because of a perceived shortage of rigorous studies of its benefits and an assumption that its success with patients has been largely a result of the psychological phenomenon known as the placebo effect.
But now, new research validates those patients' choice.
A Valid Alternative
A recent study published in the Archives of Internal Medicine concluded that acupuncture is "effective" for the treatment of chronic pain and is "a reasonable referral option" for such conditions. The study, which its authors called "the most robust evidence to date" that acupuncture actually benefits patients, was financed by the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, and conducted by researchers who spent nearly six years analyzing the raw data from 29 separate studies covering 17,922 people who had received acupuncture for back and neck pain, osteoarthritis, shoulder pain or migraines.
The new study found that acupuncture was decisively more effective than either over-the-counter pain remedies or controlled sham treatments, in which researchers told patients that they were receiving acupuncture, but the needles secretly retracted on impact or were inserted only superficially. About half of all patients treated with acupuncture reported improvements in their conditions, as opposed to about 30 percent of those who used pain remedies or received the sham treatment.
"Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo," wrote the study's lead author, Dr. Andrew Vickers of Memorial Sloan-Kettering Cancer Center in New York City. The researchers acknowledged that some patients who got the sham treatment did experience relief, indicating that there may be a placebo effect for people who believe they're receiving acupuncture. But the stronger results from authentic sessions, Vickers believes, should be enough to erase people's doubts about acupuncture. "It's not some sort of strange healing ritual," he told The New York Times.
Can Acupuncture Help You?
Acupuncture is a traditional form of Chinese medicine that has been practiced for more than 2,000 years. During a treatment, a practitioner inserts solid, hair-thin metal needles into certain anatomical points, known as "acupoints," depending on the patient's medical condition, then manipulates them, usually by twisting. In some clinics, an electrical stimulator is attached to the needles as well. (In acupressure, therapists press on acupoints with their fingers instead of needles.) A typical treatment regimen might involve weekly sessions in which needles are inserted for 20 to 30 minutes, says Dr. Stanley Wainapel, clinical director of the Department of Physical Medicine and Rehabilitation at Montefiore Medical Center in New York City. A series of treatments may involve 6 to 12 sessions.
Traditional acupuncture practitioners maintain that the body's acupoints lie along 12 channels, or meridians, through which flows vital energy, or qi. The meridians are also seen as pathways for the flow of energy between internal organs. When that flow becomes blocked or imbalanced, manipulation of the acupoints with needles can remove the block and restore the energetic balance. Some Western adherents believe acupuncture is effective because it stimulates the production of endorphins and anti-inflammatory hormones in the body. “After acupuncture,” Wainapel says, "patients have an increased secretion of endorphins, hormonal substances like cortisone and sometimes an increase in serotonin."
The World Health Organization has endorsed acupuncture for the treatment of a range of ailments including depression, sciatica, tennis elbow, dysentery, hypertension and morning sickness. Belinda Anderson, academic dean at the New York campus of the Pacific College of Oriental Medicine, has used acupuncture to treat women having trouble getting pregnant and patients with autoimmune disorders. She equates the feeling of a treatment to "runner’s high." In the early stages of treatment, the feeling lasts about two days, she says, but with more sessions, the relief lasts longer and patients feel better and sleep better.
Finding a Practitioner
Many people suffering from chronic pain seek acupuncture treatments as a complement or alternative to over-the-counter medications, surgery or other interventions, according to the National Center for Complementary and Alternative Medicine. If you're experiencing chronic pain, and medication or physical therapy have not delivered relief, or if you seek to avoid the side effects of medication or the health risks of surgery, acupuncture may be worth a try. Performed by a skilled practitioner, sessions should cause virtually no pain. Less than 1 percent of patients experience side effects, like punctured organs and infection, the latter typically caused by poor sterilization or faulty practices. The federal Food and Drug Administration regulates acupuncture practitioners and requires that their needles be manufactured according to certain standards and that they be sterile, nontoxic and labeled for single use only.
“Get a referral from someone you know and trust," Anderson says, "then call that practitioner and ask if he has treated someone with your condition in the past, how long he’s practiced and in general flesh out how professional he is." The American Academy of Medical Acupuncture and the National Certification Commission for Acupuncture and Oriental Medicine can also help you find licensed practitioners.
Needling the Doubters
Many insurance companies consider acupuncture experimental and investigational for most conditions, Wainapel says, but more are moving toward covering it for certain ailments, like chronic pain and discomfort stemming from cancer treatment. Whether your provider considers acupuncture to be a viable treatment depends on the company, the state you live in and whether the service is provided by a licensed physician. Even if acupuncture is covered, insurance companies may limit the conditions acupuncture can be used to treat and the number of sessions allowed. (Learn more about paying for acupuncture from the National Center for Complementary and Alternative Medicine.)
Some skepticism about acupuncture persists, but evidence, like the new study, is helping to overcome it. "At the end of the day, our patients seek our help to feel better and lead longer and more enjoyable lives," wrote Dr. Andrew Avins of Kaiser-Permanente, Northern California Division of Research in Oakland, in an editorial accompanying the study in the Archives of Internal Medicine. "The ultimate question is: Does this intervention work (or, more completely, do its benefits outweigh its risks and justify its costs)?" In the case of acupuncture, he continued, the new study has provided proof that the treatment delivers at least modest benefits, and so, for doctors considering their options for treating chronic pain, "perhaps a more productive strategy at this point would be to provide whatever benefits we can for our patients, while we continue to explore more carefully all mechanisms of healing."