Acupuncture: When It's Worth a Try
For more than 3 million Americans, acupuncture is one stop on their journey to find relief from chronic pain, menopause symptoms, and a host of other ailments. It involves inserting thin needles on specific points of the body like pins on a map.
Whether it's effective is "a hotly debated topic,” says Brian Berman, M.D., professor of family medicine and the founder and director of the University of Maryland Center for Integrative Medicine. “Proponents of the practice would point to research that has found it to be effective for conditions such as chronic pain, while the skeptics may question the quality of the research and attribute any benefits to a strong placebo effect.”
Certain problems inherently arise when researchers try to prove whether acupuncture is effective, Berman says. For starters, study designs are inconsistent, so researchers can’t accurately compare outcomes. Results may be swayed by the participants’ attitudes toward acupuncture, too. For example, a patient who expects acupuncture to work may be more likely to report a positive outcome than a skeptical patient would.
Still, experts aren’t quick to write off acupuncture. “Given the relative lack of side effects associated with acupuncture in contrast to some treatment avenues, such as prescription painkillers, I think this is an area of medicine that warrants further investigation,” Berman says.
What is acupuncture?
According to traditional Chinese medicine, hundreds of acupuncture points exist along meridians (pathways) on the body, which carry a form of vital energy called qi (pronounced “chee”). Eastern medical practitioners believe the mechanism that causes disease or pain is an internal imbalance between the basic forces of yin and yang, leading to a blockage of qi. Acupuncture involves stimulating these specific points on the body using various styles and techniques. This technique supposedly restores the flow of qi and thus reestablishes good health.
Modern-day Western researchers have proposed various scientific theories to explain how the ancient Chinese remedy works, but they’ve been unable to pinpoint one clear mechanism. For instance, acupuncture may reduce pain by stimulating the body’s production of analgesic (pain-relieving) chemicals such as endorphins, but studies show that placebo treatments can do that as well.
Acupuncture may have a simple counterirritant effect (purposely causing irritation or inflammation in one area to relieve inflammation in another). It may also affect connective tissue, blood flow, and aspects of the immune and nervous systems. However, none of those mechanisms would explain the supposed benefits of stimulating specific acupuncture points for different conditions or any possible long-lasting benefits.
Acupuncturists, as well as some specially trained doctors, dentists, and other medical professionals perform the treatment. The most common and most studied form of acupuncture involves penetrating the skin with ultra-thin metallic needles that therapists gently manipulate by hand.
Acupuncture is generally safe, as long as the practitioner is trained and uses sterile, disposable needles, as the U.S. Food and Drug Administration requires (FDA regulates their manufacture and labeling). A new set of needles, taken from a sealed package, should be used at each session; the treatment sites should first be swabbed with alcohol or other disinfectant.
Practitioners typically insert the needles at points far from the symptom sites. For instance, to treat back pain, the acupuncturist may insert needles in the feet or ears and back. Specialized versions of acupuncture limit needling to just one body part, notably the hands, ears, or scalp.
An acupuncturist may apply heat or electrical pulses to the needles or near the insertion points; sometimes he or she may burn an herb called mugwort near the points or apply it to the needle tips (a technique called moxibustion). The practitioner may also use his or her fingers to apply pressure (a technique called acupressure).
In a typical session, the practitioner inserts five to 20 needles and leaves them in for 10 to 30 minutes. Depending on the condition being treated, acupuncture is usually administered once or twice a week for six to 12 weeks.
Some people report feeling almost nothing. Others describe the sensation as tingling, numbness, or aching. Whether you experience pain or discomfort depends on many variables, notably the practitioner’s skill and technique, the location and depth of the insertions, and differences among you and other patients.
But, the question remains: Does acupuncture work? Although many studies on acupuncture have been flawed by including too few participants, lacking an appropriate control group, or being otherwise poorly designed, some solid research has emerged in recent years.
Below is a summary of the benefits acupuncture might be able to provide when it comes to your health.
The evidence for pain relief
One of the most common areas of acupuncture research involves its effect on chronic pain. While some studies suggest that acupuncture and “sham acupuncture” (a scientific control that’s essentially a fake or placebo intervention) have similar effectiveness when it comes to pain relief, both of these appear to be more effective than no treatment at all.
A multicenter meta-analysis, first conducted in 2012 and updated in 2014, included data on 18,000 people from 29 high-quality studies focusing on acupuncture for chronic back,neck, and shoulder pain; osteoarthritis, and chronic headaches. Sham acupuncture was used in about half the studies.
The analysis found that acupuncture reduced pain in 50 percent of participants, whereas no treatment or usual care reduced pain in 30 percent of participants. Sham acupuncture reduced pain in 42.5 percent, indicating that most of the observed benefits could be chalked up to placebo effects. Nevertheless, the researchers concluded that acupuncture had “clinically relevant” effects, albeit small ones, on chronic pain over those of sham acupuncture.
Overall, research scrutinizing acupuncture’s ability to relieve pain has been promising. It may be beneficial for:
- Chronic back pain. Sham and real acupuncture may be equally effective at providing short-term relief. According to clinical practice guidelines issued by the American Pain Society and the American College of Physicians, acupuncture is one of several alternative therapies that should be considered when people with chronic lower back pain don’t respond to conventional treatment.
- Neck pain. Acupuncture may help relieve neck pain better than standard care; in small studies, it provided more relief than sham treatments.
- Headaches. Acupuncture can be at least as effective as drugs for the prevention of migraine, tension, or cluster headaches, with fewer side effects; real and sham acupuncture may be equally effective.
- Osteoarthritis. Real and sham acupuncture may be similarly beneficial.
- Postoperative pain. Acupuncture may be more effective than sham acupuncture for reducing pain after surgery and may lessen the need for pain relievers.
- Aromatase inhibitor side effects. Electroacupuncture, which uses electrical currents in acupuncture needles to stimulate various body parts, might quell the hallmark joint pain and stiffness caused by taking aromatase inhibitor drugs, the antihormonal therapy used after breast cancer. It may also relieve other side effects, including fatigue, anxiety, and depression.
Many women search for relief from the symptoms of menopause such as hot flashes and night sweats, but traditional hormonal therapy may not be an option for everyone—particularly women who’ve had breast cancer. While some research has found that acupuncture wasn’t superior to sham acupuncture, two recent studies seemed to offer promise:
• A National Institutes of Health–sponsored study, appearing in 2016 in the journal Menopause and conducted at Wake Forest Baptist Medical Center in North Carolina, found that among 209 women ages 45 to 60, acupuncture could reduce hot flashes by up to 36 percent. Researchers cautioned that additional treatment or an expectation that the treatment would work could have affected results. Other research has pointed to acupuncture being no better than sham procedures.
• Taiwanese researchers conducted a systematic review and meta-analysis of 34 trials that included more than 2,400 women. Publishing online in February 2016 in Obstetrics and Gynecology, they reported that women who used acupuncture were able to find some relief from menopause-related sleep disturbances. Participants who received acupuncture had elevated levels of estradiol, a form of estrogen that seemed to correlate to better sleep.
Easing breathing problems
Several studies have reported that acupuncture can help people with chronic obstructive pulmonary disease (COPD). A 2012 study found that 12 weekly sessions reduced shortness of breath and improved exercise tolerance and quality of life better than sham acupuncture; both groups received standard medical care for COPD.
Nausea is a common side effect of anesthesia and chemotherapy. Many studies have found benefits from acupuncture in these instances, though results have been inconsistent regarding its superiority to sham acupuncture.
Still, according to the National Cancer Institute, the evidence for a benefit is convincing and consistent. Most of the research has focused on a single acupuncture point known as P6, located on the inside of the forearm just above the wrist.
Not for all conditions
Though acupuncture has been touted to help irritable bowel syndrome and hay fever, the benefits—if any—remain unclear. Areas that lack convincing evidence to support the use of acupuncture include weight control, urinary incontinence, asthma, hypertension, diabetes, and tinnitus (ringing in the ears); nor is there any proof that acupuncture is a general “immunity booster.”
“It’s fine to try acupuncture when conventional therapy doesn’t work or if you’re concerned about side effects from pain relievers, for example, but it’s also important to remember that acupuncture doesn’t work for everyone, and it should never take the place of standard medical treatments or delay diagnosis and treatment,” Berman says. “The bottom line is, if you’re not a candidate for other pain-relief options or you’ve tried other treatments without success, there’s no harm in trying acupuncture, and possibly a lot to gain.”
Finding a practitioner
If you have pain or a medical condition that doesn’t respond to conventional treatments, ask your doctor or other health care provider if acupuncture might help—and if so, ask for a referral to a practitioner. Or contact your local hospital.
Go to a licensed acupuncturist if you live in one of the 44 states (plus the District of Columbia) that have licensing. This usually requires at least three years of training and passing a national board-certification exam administered by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).
If you live in a state that does not license acupuncturists (Alabama, Kansas, North Dakota, Oklahoma, South Dakota, and Wyoming), ask to see evidence that the acupuncturi at least three years of training at an accredited institution.
To find a certified acupuncturist in your area, go to NCCAOM.org or call 904-598-1005.