What is acupuncture?
Acupuncture is a treatment that physiotherapists use as part of an integrated approach primarily for pain relief. Fine needles are inserted into the skin and are ‘stimulated’ e.g. by rotating the needle. It is believed to have been in use for over 1000 years and traditionally comes from Chinese medicine. As physiotherapy is an evidenced-based profession, I practice ‘Western-style acupuncture’. This is acupuncture that has a scientific basis.
The AACP website gives us this insight:
“Acupuncture can reduce pain by stimulating the brain and spinal cord to produce natural pain-relieving chemicals such as endorphins, melatonin (which promotes sleep) and serotonin (to promote well-being), to name but a few. These chemicals assist the body’s healing processes and offer pain relief as a precursor to other treatments such as manual therapy or exercise in order to aid recovery.”
Read more from the AACP here.
A brief history of Western-style acupuncture
Little was known by the general public about acupuncture in Western countries until President Nixon visited China on a state visit in 1972. A New York Times journalist, James Reston, was also on the journey and developed appendicitis. After his appendix was surgically removed, his post-operative pain was treated with acupuncture. On return to America, he wrote about his experience in the New York Times, and it is thought this is when acupuncture’s popularity in the West started to grow.
What to expect
Studies suggest acupuncture is effective on 70-85% of people. Needles are inserted into different positions, often not felt as they are so fine. The needles are then stimulated, for instance, by rotating the needle in its site, to achieve one of the following sensations:
* Numbing or
* An ache
Acupuncture has a great safety record
Acupuncture is a safe treatment when undertaken by suitability qualified individuals (White et al. 2001; MacPherson et al. 2001; White 2006; Xu s. et al. 2013)
As a member of the Acupuncture Association of Chartered Physiotherapists, I follow safe guidelines however, as with any intervention, there are the potential for side effects.
The most common adverse side effects are:
* Bruising or bleeding at the site of the needle (3%)
* Feeling light headed, nauseous
* Tiredness (3%)
* Aggravation of symptoms (1%)
The benefits far outweigh the risks for the majority of people and as such acupuncture has been listed as a treatment option by NICE, SIGN, and the University of York Centre of Reviews & Dissemenation.
All needles used are from Phoenix Medical supplies, made from the highest quality Japanese surgical stainless steel. They are sterile and single use therefore minimising further the small risk of infection.
Acupuncture is a safe alternative if you cannot tolerate, or prefer not to use, conventional analgesic medications. Please always consult your doctor before changing your medications.
Acupuncture: real or placebo? The debate.
The gold-standard for research is the ‘RCT’ – the randomised controlled trial whereby the both patient and clinician are blinded to the treatment. This is difficult to successfully implement in many cases as most sham acupuncture still punctures or puts pressure the skin. Many studies have objectively demonstrated the physiological changes that happen in the body during acupuncture needle insertion and more so during needle stimulation. These changed can be observed both in the blood and through functional MRI scanners.
However the majority of studies result in a small but significant improvement in patient symptoms or no significant improvement at all and almost all recommend further research. By now there has been a multitude of studies of varying quality, so why if acupuncture works on 70-80% of people do these studies not show this? Some feel that an RCT is not the best way to test this treatment…so what do they think is the best way to test it and why??
Some have suggested that relaxation is key to the success of acupuncture or attention from the therapist or a combination of these factors.
Interestingly, expectation has a dramatic impact on treatment outcome as several studies have shown.
Conditions that can benefit from acupuncture
NHS choices gives a summary of the conditions that can benefit from acupuncture based on studies, click here to read about it. Lee & Ernst (2011) concluded that acupuncture is effective for migraines, neck disorders, tension-type headaches, and peripheral joint osteoarthritis after appraising 8 Cochrane reviews. Cochrane reviews are know for their high quality studies with rigorous methodology.
A review of 29 randomised controlled trials found that acupuncture is effective for the treatment of chronic pain and the benefit achieved using acupuncture is significant compared to sham treatment in order to conclude acupuncture is more than a placebo Vickers et al. (2012) for the University of York CRD.
Low Back Pain
NICE recommends offering an exercise programme, a course of manual therapy or acupuncture according to patient preference in the early management of persistent non-specific low back pain. Specifically, acupuncture needling comprising up to a maximum of 10 sessions over a period of up to 12 weeks.
“For chronic low-back pain, results show that acupuncture is more effective for pain relief than no treatment or sham treatment, in measurements taken up to three months. The results also show that for chronic low-back pain, acupuncture is more effective for improving function than no treatment, in the short-term.”
But more importantly, acupuncture as an adjunct to conventional treatment:
“When acupuncture is added to other conventional therapies, it relieves pain and improves function better than the conventional therapies alone.” (Furlan et al. 2005)
Peripheral joint osteoarthritis
Acupuncture cannot reverse structural changes of a joint, however benefits can be felt in pain and function by treating symptoms and by reducing inflammation.
The Scottish Intercollegiate Guidelines Network (SIGN) state that a randomised controlled trial of “patients with osteoarthritis of the knee or hip reported a significant difference at three months between acupuncture and routine care.”
A Cochrane review of randomised controlled trials concluded that “acupuncture for peripheral joint osteoarthritis suggest statistically significant and clinically relevant benefits” (Manheimer et al. 2010).
There is “low to moderate evidence that compared to no treatment or standard treatment, acupuncture improves pain and stiffness in people with fibromyalgia” and effects are still present one month (Deare et al. 2013).
Acupuncture can provide relief for patients with plantar fasciitis (Zhang et al. 2011; Clark et al. 2012). Substantial improvements in pain and function was observed when combining acupuncture to standard treatment (including non-steroidal anti-inflammatory drugs). Pericardium 7 was a point reported to be beneficial in both studies.
Acupuncture combined with 15 physiotherapy sessions in 3 weeks improves shoulder function and alleviates pain, compared with physiotherapy as the sole treatment. This improvement is accompanied by a reduction in the consumption of analgesia (Vas et al. 2008).
Gadau et al. (2014) reviewed 10 randomised controlled trials and found that acupuncture can reduce lateral elbow pain for up to 6 months and was superior to sham controls. There is further support from other systematic reviews (Farren 2012; Trinh et al. 2004).
NICE guidelines asks us to consider a course of up to 10 sessions of acupuncture over 5–8 weeks for the prophylactic treatment of chronic tension-type headache.
Migraines decreased in intensity and frequency with benefits that continued even 3 months after last acupuncture treatment (Plank et al. 2013). The treatment consisted of twice a week acupuncture treatments for 4 weeks followed by once a week treatments for a further 4 weeks. Linde et al. (2009a) studied 22 randomised-controlled trials and recommends the consideration of acupuncture for migraine prevention (prophylactic treatment) particularly for those refusing prophylactic drug treatment. Also, the report confirms that acupuncture has fewer adverse side effects than drug medication.
There is moderate evidence that acupuncture relieves pain better than some sham treatments and that those who received acupuncture reported less pain at short term follow-up than those on a waiting list. There is further moderate evidence that acupuncture is more effective than inactive treatments for relieving pain post-treatment and this is maintained at short-term follow-up. (Trinh et al. 2006)
In chronic neck pain Witt et al. (2006) demonstrated the addition of 15 acupuncture sessions over 3 months to routine care reduced neck pain and disability compared to routine care alone. Treatment benefits were maintained at 6 month follow-up.