Medical Acupuncture

On November 3-5, 1997, the U.S. National Institute of Health Consensus Development Conference issued a statement by its independent panel of experts stating that “ promising results have emerged showing efficacy of acupuncture in adult post-operative and chemotherapy nausea vomiting and post dental surgery pain.” There is clear scientific evidence to support the use of acupuncture in theses conditions.

There are other conditions where acupuncture may be effective.  These are addiction, stroke rehabilitation, headaches, menstrual cramps, tennis elbow, fibromyalgia, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma.

There are 12 studies for the treatment of nausea using the point pericardium 6 (P6). Of these twelve studies, the results of 10 studies were positive.  These studies used a variety of acupuncture techniques such as acupressure, manual stimulation of acupuncture needles, and electrical stimulations.  Some of these studies were done on patients with pregnancy induced nausea.  Others were performed with patients under chemotherapy or post-operative nausea.   The findings were significant and safe that the Canadian Society of Obstetric and Gynecology recommended P6 to be used as a conventional treatment to treat women with pregnancy related nausea in 1996.  
In a systematic review by Enest and Pittler in 1998, (The Effectiveness of Acupuncture in Treating Acute Dental Pain: A Systematic Review) the authors concluded that acupuncture can relieve dental pain and that future investigations should define the optimal acupuncture technique and its relative efficacy compared with conventional methods of analgesia.  There were 16 controlled studies included in this systematic review.  Of these, 11 trials were randomized with 7 positive trials.  Since this review, there was another high quality RCT identified throuhg Medline search up to May 2000 for dental pain.  The Study “ Evaluation of Acupuncture for Pain Control After Oral Surgery” by Lao et al in 1999.  This study indicated that acupuncture is superior to the placebo in preventing postoperative dental pain.  In this study, a noninsertion placebo procedure was introduced.  It was tested successfully as a valid placebo

Most of the acupuncture studies are done on patients with musculoskeletal pain.  Of these conditions, back pain studies were the most frequently done.  There are several studies yielding positive result comparing either acupuncture treatment to acupuncture treatment over ineffective points, over sham points (superficial insertions), and compare with conservative treatments. There are 2 systematic reviews on acupuncture in the treatment of back pain.  There is no RCT for acute low back pain.  The two systematic reviews included similar studies in their analyses.  Interesting, the authors reached different conclusions. Tulder et al used a qualitative review based on 11 studies and concluded there is limited evidence that acupuncture is not more effective than placebo.   Some of the flaws in these studies included high drop out rate, blinding issues, and small sample size etc.

There is one study looking at the effect of acupuncture using on chronic lateral elbow pain.  This study demonstrated that with dry needling stimulation over GB34, patients reported greater pain relief in their pain intensity on the visual analog scales.  The study was stopped prematurely due to the significant result (p<0.01).  In this study, the patients in the control group had treatments using an acupuncture point in their backs.

Patients with fibromyalgia were treated with acupuncture using the points LI4 bilateral, ST36 bilateral and a few trigger points.  These points were stimulated electrically.  The control group had acupuncture needles inserted a few cm away superficially from the true acupuncture points.  The acupuncture group reported significant decrease in their pain threshold and amount of analgesics used.

Patients with menstrual cramps could be helped by acupuncture.  Patients with primary dysmenorrhea were randomized into the acupuncture group or the control group.  The control group received TENS treatments.  These patients were treated twice in the week before their menses for about 5 months.  Patients in the acupuncture group have significant pain relief of 3 months or more (p<0.001).  There was also a decrease in the amount of analgesic used in a subgroup treated with periosteal stimulation.  

There is no doubt that the quality of studies involving acupuncture is no where close to the caliber of some field of conventional medicine such as cardiology.  However, the caliber of acupuncture studies is probably comparable to the conventional MSK treatments such as NSAIDs use, “physiotherapy”, and cortisone injections.  For example, many physicians had prescribed NSAIDs for longer than “short term” use for shoulder pain.  The evidence in this area is also quite limited. 

The lack of evidence for effectiveness is not the same as evidence for the lack of effectiveness.  The most important issue is whether, with our help, our patients feel better and can return to their regular activities.

  Cocchrane Collaboration Systematic Review Data Base

  Canadian Society of Obstetric and Gyneacology Practice Guideline. 1996.

  Molsberger A, Hille E.  The analgesic effect of acupuncture in chronic tennis elbow pain.  Brit J Rheum. 1994; 33:1162-1165.

  Deluze C, Bosia L, Zirbs A et al. Electroacupuncture in fibromyalgia: results of a controlled trial. BMJ. 1992; 305:1249-52.

  Arner S. Differentiation of pain and treatment efficacy. Dissertation. Karolinska institutet, Stockholm, 1991. In Thomas M. Lundeberg T.  Does Acupuncture Work? Pain. 1996;4: 1-4.

  Green S, Buchbinder R, Glazier R, Forbes A.  Systematic Reviews of randomized controlled trials of interventions for painful shoulders. BMJ. 1998; 315: 354-60.