Acupuncture

Aka: Acupuncture

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II. Indications

  1. Probable efficacy: Based on NIH Consensus statement (1997)
    1. Adult post-operative pain
    2. Chemotherapy-Induced Nausea
    3. Post-operative Dental Pain
  2. Probable efficacy: Additional indications based on more recent research
    1. Migraine Headache Prophylaxis, Tension Headaches and Chronic Daily Headache
      1. Alecrim-Andrade (2008) Clin J Pain 24(2): 98-105 [PubMed]
      2. Coeytaux (2005) Headache 45(9): 1113-23 [PubMed]
      3. Da Silva (2015) Headache 55(3): 470-3 [PubMed]
      4. Linde (2016) Cochrane Database Syst Rev (4):CD007587 [PubMed]
      5. Linde (2016) Cochrane Database Syst Rev (6)CD001218 [PubMed]
      6. Streng (2006) Headache 46(10): 1492-1502 [PubMed]
      7. Witt (2008) Cephalgia 28(4): 334-45 [PubMed]
      8. Yang (2016) Acupunct Med 34(2): 76-83 [PubMed]
    2. Osteoarthritis-related Joint Pain (esp. Knee Osteoarthritis)
      1. Corbett (2013) Osteoarthritis Cartilage 21(9): 1290-8 [PubMed]
      2. Manheimer (2010) Cochrane Database Syst Rev (4):CD001977 [PubMed]
      3. White (2007) Rheumatology 46(3): 384-90 [PubMed]
      4. Woods (2017) PLoS One 12(3): e0172749 [PubMed]
    3. Chronic Low Back Pain
      1. Acupuncture for Chronic Low Back Pain has good statistical and clinical efficacy
      2. Less evidence for Acute Low Back Pain
      3. Qaseem (2017) Ann Intern Med 166(7):514-30 [PubMed]
      4. Lam (2013) Spine 38(24):2124-38 [PubMed]
      5. Taylor (2014) Pain Pract 2014;14(7):599-606 [PubMed]
      6. Wellington (2014) Neuromodulation (17 suppl 2): 24-30 [PubMed]
      7. Yuan (2008) Spine 33(23): E887-E900 [PubMed]
      8. Witt (2006) Am J Epidemiol 164(5): 487-96 [PubMed]
    4. Chronic Neck Pain
      1. Witt (2006) Pain 125(1-2):98-106 [PubMed]
      2. Fu (2009) J Altern Complement Med 15(2):133-45 [PubMed]
  3. Possible efficacy
    1. Chemical Rehabilitation
    2. Cerebrovascular Accident rehabilitation
    3. Dysmenorrhea
    4. Lateral Epicondylitis
    5. Myofascial Pain including Fibromyalgia
    6. Carpal Tunnel Syndrome
    7. Asthma

III. History

  1. Bian Stone Needles (dating to New Stone Age 4,000 to 10,000 years ago)
    1. First needles used as healing instruments
    2. Over time stone needles replaced by bamboo, animal bone slivers, copper and other metals
  2. Current Needles
    1. Rounded-tips with gauge of a human hair
    2. Sterile, single-use surgical steel needles
    3. Inserted either free-hand or with plastic guide tube
    4. Designed to push tissue to the side as opposed to standard needles which cut the skin
  3. Basis
    1. Health is maintained by remaining in balanced state
    2. Qi energy flows through the body along Meridians and this is disturbed by illness
    3. Acupuncture is postulated to Restore normal energy flow (Qi)
    4. Body is traversed by 12 main and 8 extra Meridians
    5. Meridians contain >400 Acupuncture points in which the Qi flows closer to the surface
      1. Meridians are analogous to highways
      2. Acupuncture points are analogous to on and off ramps to the highways (Meridians)
    6. Microsystems exist that map to broad regions (similar to homonculous)
      1. Auricular
      2. Scalp
      3. Palm
      4. Alimi (2002) Acupuncture [PubMed]
  4. Modern modifications
    1. Percutaneous nerve stimulation (electroacupuncture)

IV. Mechanism: Theories

  1. Gate Control Theory of pain
    1. Spinal cord transmits pain signals to the brain through high-traffic gates
    2. Acupuncture generates faster signals that block slower pain signals from reaching the brain
  2. Electrical Theory
    1. Body generates very low level electrical discharges (these can be detected by monitoring)
    2. Cell maturation and function is affected by electrical fields
    3. Acupuncture points are concentrated in areas of low electrical resistance
    4. Stimulating Acupuncture points alters chemical Neurotransmitters
      1. Functional MRI demonstrates release of endogenous Opioids, Serotonin, Norepinephrine
      2. Released mediators affect Nociceptors, inflammatory Cytokines and pain Perception
  3. Neurohormonal theory
    1. Acupuncture stimulates natural endorphins from the brain and results in Analgesic effect

V. Efficacy

  1. Acupuncture practitioners have variable training and techniques making effects more difficult to study
  2. Pain appears to be better managed with more needles used and more treatment sessions attended
    1. MacPherson (2013) PLos One 8(12):e77438 +PMID:24146995 [PubMed]

VI. Adverse Effects: Severe and typically preventable reactions

  1. Infection
    1. Associated with non-sterile needle use
    2. In U.S., practitioners should use sterile, single-use needles
  2. Organ puncture (esp. lung, Bladder)
  3. Allergic Reactions to needle
    1. Associated with use of needle materials other than surgical steel

VII. Adverse Effects: General

  1. Localized inflammation at needle sites
  2. Localized bleeding at needle sites

VIII. Resources

  1. American Academy of Medical Acupuncture Courses and Education
    1. https://www.medicalacupuncture.org/For-Physicians/Education/Ongoing-Courses-Colleges-and-Acupuncture-Schools
  2. Video: What Happens During an Acupunture Session
    1. https://www.youtube.com/watch?v=JnKPNw9K2Ng&feature=youtu.be
  3. Video: Back Pain Acupuncture Treatment
    1. https://www.youtube.com/watch?v=fqUuPkaHFDI&feature=youtu.be

IX. References

  1. Chon (2008) Mayo Selected Topics in Internal Medicine, Lecture
  2. (1997) Acupuncture 15(5): 1-34 [PubMed]
  3. Kelly (2019) Am Fam Physician 100(2): 89-96 [PubMed]

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