So, is the acupuncture effect real or simply a placebo effect? If it is real, is acupuncture in reality point specific? The study attempted to answer some of these questions using functional brain imaging. The data suggests that acupuncture stimulation clearly desensitizes or reduces activation in the cortical areas that are believed to be involved with pain signal processing, thereby alleviating pain perception. The data also supports the efficacy of acupuncture in pain relief, and support the biological bases of acupuncture analgesia. Conversely, the sham acupuncture + pain study strongly suggests that the point specificity claimed by acupuncturists and by the traditional acupuncture literature is not fully supported in these experiments. However, the study suggests that traditional acupuncture points indicated for pain control are more effective than “sham” points since the meridian acupuncture points appear effective with less stimulation than the sham point.
Validity
Dr. Zang-Hees’ journal was part of a collection of journals from the American Academy of Medical Acupuncture. The purpose of the American Academy of Medical Acupuncture is to promote the integration of concepts from traditional and modern forms of acupuncture with Western medical training and thereby synthesize a more comprehensive approach to health care. The fact that the scientist is actively involved in this institution questions the validity of the source and raises suspicions of ulterior motives. However, Dr.Zang-Hee attempted to prove various disputed facts about acupuncture using science and acknowledged that his results were fairly inconclusive in determining the difference between “sham” acupuncture and meridian acupuncture.
Functional Magnetic Resonance Imaging (fMRI) is a type of specialized MRI scan. It measures the hemodynamic response (change in blood flow) related to activity in the brain or spinal cord of humans. Dr. Zang-Hee drew his conclusions solely based on fMRI. Although fMRI is widely used and accepted as reliable by many scientists, the images produced must be interpreted carefully, since correlation does not imply causality, and brain processes are complex and often non-localized.
Various other studies have also concluded that acupuncture provides effective pain relief, thus increasing reliability.
The Heidelberg Study14
The Heidelberg study, 52 athletes suffering from shoulder pain were divided into a control group and an acupuncture group. Each group received eight 20-minute sessions over a four-week period. The project was a single-blind study; the acupuncturists who administered the needles were aware of the different treatments involved, but the subjects were not.
The acupuncture group received traditional acupuncture therapy, with needles inserted through a plastic ring affixed with plaster into a combination of 12 acupoints according to the patient's symptoms. The control group were treated using a special "placebo-needle" designed by one of the researchers. The placebo needle had a blunt tip which only touched, but did not penetrate, the subject's skin. Patients in the control group would feel a small pricking sensation and "see" the needle being inserted without it actually doing so.
Patients were rated using the modified Constant-Murley score, assigning points to the level of the subject's pain; their ability to perform daily activities; the painless range of motion in their shoulder; and the maximum amount of power in their shoulder. Patients in the control/placebo group improved by an average of 8.37 points after receiving treatment. Scores from the acupuncture group, meanwhile, improved an average of more than 19.2 points after treatment. Seventeen patients in the acupuncture group (68%) gave the treatment a positive evaluation after the final treatment as opposed to only 14 patients (52%) in the control group.
Based on these results, the authors concluded that "acupuncture with penetration of the skin is more effective than placing the needles on similar sites." However, the authors were quick to point out the study's limits, stating that the treatment "only demonstrates the effectiveness of the needling procedure in rotator cuff tendinitis" and calling for a larger, double-blinded study to prove the effectiveness of acupuncture as opposed to placebo.
The New Jersey Study14
The New Jersey study, while smaller, produced similarly encouraging results. Twelve patients were monitored using functional magnetic resonance imaging (fMRI), a technology that reveals what parts of the brain are receiving increased blood flow. Increased blood flow to different areas of the brain indicates that those areas of the brain are being stimulated.
The patients were subjected to pain in the form of a tiny filament used to prick the inside or outside of their upper lip. Initial tests showed via fMRI that all 12 people reacted strongly to the pain stimulus, as there was an increased flow of blood to the subjects' parietal areas and brain stems.
Concurrently with being pricked with the filament, seven subjects received traditional acupuncture at the Hegu point, an acupoint located between the thumb and forefinger. The remaining five subjects received electroacupuncture at the Hegu point, with a low-level electrical current being delivered through the needle.
During 30 minutes of treatment, the patients rated their pain level on a scale of one to 10 every five minutes, with the fMRI continually monitoring their brains. In four of the seven subjects who received traditional acupuncture (57%), the fMRI showed considerably decreased levels of brain activity associated with the pain.
"We found activity subsided in 60 to 70 percent of the entire brain," said Wen-Ching Liu, an assistant professor of radiology at UMDNJ and a co-author of the study. "Interestingly, in each subject, we detected pain-induced activity in different areas of the brain."
The response was even greater among those who received electroacupuncture. Pain-related brain activity decreased in all five patients who received electrical stimulation, and those subjects showed a greater tolerance to pain than those who received traditional acupuncture treatment.
"We could see the brain activity associated with the pain subsiding even as the patients reported they were experiencing relief," added Dr. Huey-Jen Lee, the study's lead author. Lee noted that since the MRI definitively showed different brain activity, it was highly likely the increased tolerance to pain was real and not a placebo effect.
"The brain actually shows differences," Lee said, "and that is convincing."
Although the results of the study appear favorable for those who have been looking for proof that acupuncture works, Dr. Lee warned against jumping to conclusions. "It's still premature," she said of the study results. "We'd like to get more data."
Implications
Economical6
Although acupuncture treatment itself is cheap, many doctors are discouraged from entering this field as it isn’t as rewarding as conventional medicine. The greatest misperception of all may be around the financial "benefits" doctors receive by providing acupuncture. The reality is that most physicians who choose to get trained and provide medical acupuncture as part of their medical specialty take a pay cut. The simple fact is that acupuncture requires time and physicians are paid more or less based on the number of patients they can see each hour. Most hospitals and HMOs do not support treatment rooms being used for patients resting with acupuncture needles placed for 20-30 minutes when those same rooms can be used for 3 to 6 regular patient visits in the same span of time.
In addition, the reimbursement for office visits and minor office procedures which are covered by insurance, are at least 2-3 times greater than for acupuncture, which often is not covered by insurance. This creates a double risk situation where not only is income per unit time lower, but the chances of receiving actual payment is diminished by the insurance industry's ability to discount or deny payments altogether.
In order to practice acupuncture successfully, doctors must often remove themselves from the conventional medical environment, or forego practicing acupuncture altogether. Bear in mind that few doctors have adequate business management and marketing training to successfully take on such an endeavor. According to an October 2006 AAMA Newsletter report entitled, Survey Profiles Typical AAMA Member, those physicians not using their interest or training in medical acupuncture cite such reasons as, "training time and cost, low reimbursement from third parties, reduced demand, length of treatment, lack of hospital facilities", and other obstacles. These challenges are not that different from those faced by licensed acupuncturists. The survey further states that on average physicians use acupuncture for only 25% of their clinical cases while relying on conventional methods for the other 75%.
Social6
Physicians who do stay in their conventional medical environments often pay a social price. Depending on the relative acceptance of acupuncture as a legitimate medical modality, medical acupuncturists may be regarded as outcasts within their field and discipline. Right or wrong many MDs still regard acupuncture as "quackery".
The truth is Medical Acupuncturists are pioneers and they are paying the social and economic prices of forging new territory.
There are many physicians who have taken steps to advance the acupuncture profession as a whole, however it becomes problematic when there are those licensed acupuncturists who criticize physicians for their "inferior training" as medical acupuncturists. You can see how this can create an unnecessary and ultimately harmful divide between two disciplines within the same health profession.
Medical acupuncturists are often at the forefront of acupuncture research, public education, and policy making. Many TCM acupuncture schools have physician acupuncturists on their staff and on their Board. The same is true for many physician acupuncture training programs where licensed acupuncturists teach and contribute significantly to the core curriculum
Benefits and advantages of Acupuncture7
According to traditional Chinese medicine (TCM), the main idea behind acupuncture is to restore and maintain health by working on vital energy (Qi) points of the body. It is widely used by acupuncturists, dentists, physicians and other health practitioners for relieving pain and several other health related problems. Let’s see the advantages of acupuncture.
One of the most important advantages of acupuncture is that there are no side effects, if carried out by a registered and well-trained practitioner. The NIH (National Institutes of Health) has reported that acupuncture has lower adverse effects compared to the prescribed medications and other medical procedures followed for treatment of the similar conditions.
Acupuncture can be performed in any age group such as children, adults and elderly persons. Usually it does not hurt and is done without disturbing other treatments and medications. Even people who have a compromised immune system can benefit from acupuncture treatment.
Studies have found out that acupuncture can be used to treat both physical and mental illnesses. It is also useful for treatment of chronic diseases. It helps in improving memory, boosting immune system, and in regulating hormones. Many people have reported that they get relief from headache, back pain, joint pain, insomnia, stress and fatigue after completing prescribed acupuncture sessions. It restores energy and increases overall stamina of the body.
It has been suggested that acupuncture is used for effective treatment of osteoarthritis, hearing loss, dental pain, asthma, diabetes, infertility, migraine, tennis elbow, allergies, hypertension and several other diseases. However, more researches need to be done to identify various acupoints of the body and understand the effects of acupuncture on brain during treatment.
Risks and disadvantages of Acupuncture8
Acupuncture is a safe process when performed by someone who knows what they are doing. However, if not, complications may occur. A punctured lung or spinal cord injury can occur if someone doesn't know what they are doing. Though these occurrences are indeed rare, they do happen. A person who hasn't been trained to utilize the proper delivery of acupuncture can damage another person permanently which is why it is so important to know who you go to for acupuncture treatments.
A trained acupuncturist knows the dangers of sharing needles and will always dispose of them after every use. If you find someone who doesn't do this then naturally, you shouldn't just leave but you should also report them due to the dangers and risks of Hepatitis and the risk of HIV and AIDS. The risks are very real if the acupuncturist is not using clean, NEW needles on every person.
People from around the world can just refer to themselves as acupuncturists because at present it is not recognized as a field which would mandate a license to practice.
Very rare cases of complications are reported from use of acupuncture. However, certain problems of infection and organ rupture are observed if not delivered properly. Always make sure that the acupuncturist is registered and qualified enough to perform acupuncture, otherwise there may be chances of improper needle placement that can lead to bleeding, swelling and pain in the treatment site.
The York acupuncture safety study carried out a prospective survey of 34000 treatments by traditional acupuncturists. This study found that no serious adverse events occurred for 95% of the cases10.
The record of acupuncture’s safety is very impressive. The mechanism itself is relatively safe and non-invasive, however, if performed by the wrong people – it could be lethal.
Alternative treatments - Chronic Pain9
Pharmacologic Treatment
Acupuncture itself isn’t considered as a conventional treatment, rather as an alternative. Many of those who opt for acupuncture are people who suffer from chronic pain.
A significant number of people are affected by chronic pain worldwide.
-
Chronic pain affects approximately 25 percent of the U.S. population11
-
Almost three-fifths of adults 65 and older with pain in the United States said it had lasted for one year or more.11
-
Nearly 1 in 5 adults in Europe suffers from long-term pain – at least 75 million people.12
A variety of medications are used to treat chronic pain, and a physician can determine which medication is appropriate for the individual patient based on duration and severity of back pain. Acetaminophen and nonsteroidal anti-inflammatory drugs are typically tried first. Opioid medications are also a possibility for those with severe pain, but they should only be used for a short period of time and under supervision by a physician because of the possibility of dependence.
Muscle relaxants are frequently prescribed for short-term use in conjunction with acetaminophen or nonsteroidal anti-inflammatory drugs for chronic pain. However, there is no evidence to suggest that muscle relaxants should be used for prolonged periods of time.
Antidepressants (i.e., tricyclic antidepressants), benzodiazepines and antiepileptic medications have been studied for use in chronic pain.
Exercise
Supervised exercise that incorporates stretching and strengthening can be beneficial in managing chronic back pain. Exercise not only improves back symptoms, but it also has overall health benefits. With instruction from a professional, individuals can be taught exercises that centralize symptoms, improve balance, posture and coordination, and relieve muscle tension.
Yoga has benefits for chronic back pain. Although there are many specific styles of yoga, most involve a combination of body positions, breathing and relaxation. Regardless of the type of exercise, individuals with chronic low back pain should avoid bed rest and remain active.
Physical conditioning in chronic pain patients can have immediate and long-term benefits, according to a new study presented at the American Academy of Pain Medicine 24th Annual Meeting. 13
A frequent comorbid condition of chronic pain is profound physical deconditioning, which results from inactivity. "People with chronic pain don't want to exercise — the main reason is that they are in so much pain," the study's lead investigator, Amy M. Burleson, PsyD, from the Cleveland Clinic Foundation, in Ohio, told Medscape Neurology & Neurosurgery here. "We were hoping this [study] would show people how important exercise is."
Bibliography
-
-
- Acupuncture interview with Bruce Pomeranz.
-
Medical Acupuncture
A Journal For Physicians By Physicians
Volume 14 / Number 1
-
- implications
-
- advantages and disadvantages
-
- alternative treatments
-
- safety rate
- Bonica, Bonica’s Management of Pain, “History of Pain Concepts and Therapies,” 2001
- Pain in Europe Study, 2003
-
- chronic pain
-
Images
Figure 1 -
Figure 2 –
Figure 3 –
Figure 4 –
Note: I collated, listed and accessed all my sources on the 26th of January 2011.
Validity of Sources
Wikipedia
Wikipedia is an online open-content collaborative encyclopaedia, that is, a voluntary association of individuals and groups working to develop a common resource of human knowledge. The structure of the project allows anyone with an Internet connection to alter its content. Wikipedia cannot guarantee the validity of the information found on it. The content of any given article may recently have been changed, vandalized or altered by someone whose opinion does not correspond with the state of knowledge in the article. Acupuncture is a topic which invites much debate. There is a vast difference of opinions between scientists and traditional Chinese physicists, and even between scientists themselves. For this reason, I didn’t use Wikipedia as one of my main sources.
However, Wikipedia illustrates the contradictions surrounding this topic and this can be useful in comparing and collating data on different ideas on the issue.
Sources used that promote acupuncture.
Several sources were used from sites that clearly were promoting the benefits of acupuncture, for example:
The purpose of the American Academy of Medical Acupuncture is to promote the integration of concepts from traditional and modern forms of acupuncture with Western medical training and thereby synthesize a more comprehensive approach to health care. The fact that the organisation is actively involved in promoting acupuncture and sealing treatments questions the validity of the source and raises suspicions of ulterior motives. However, this site provided scientific evidence backed up with data, studies and research.
Various other studies have also concluded that acupuncture provides effective pain relief, like the ‘Heidelberg study’ and the ‘New Jersey study’, thus increasing reliability.
