For Medical Providers

 

Introduction: Acupuncture has remained mostly unchanged since its approximate conception around 200 B.C. in China. Today, millions of patients seek treatments for a variety of disorders from pain syndromes to medical diagnoses such as anxiety and fibromyalgia. A survey also showed that a majority of patients would seek CAM therapies if suggested/approved by their doctor. Many patients are now seeking therapies that do not include more medication burden due to cost and potential side effects. In these few paragraphs, I would like to summarize the uses of acupuncture and help integrate it into your treatment plans as a viable, safe alternative for many conditions.

Research: Perhaps the biggest obstacle to physicians recommending acupuncture, or any other complimentary medical therapy, is the lack of Evidence Based Medicine (EBM) proof. Unlike pharma and other institutional research, the studies for acupuncture were notoriously poorly designed and under funded. There are also some inherent difficulties in studying acupuncture compared to a medicinal trial. These include the incomplete understanding of the physiologic effects, ineffective blinding of patients, unclear adequacy of dose, difficulty in identifying suitable sham or placebo, and use of standardized treatment regimens rather than individualized approach that characterizes acupuncture.

Some of these issues are being resolved now and more high level research has been produced over the last 20 years. The studies have included thousands of patients and have been published in prestigious journals, such as Annals of Internal Medicine, Spine, Headache, Pain, and Clinical Journal of Pain. Several of the more notable articles are referenced at the end of this section.

An excellent review article is contained in American Family Physician from 2009; Dr. Kelly did a review of the available evidence from controlled studies and evaluated the effectiveness using a grade of “A” for consistent, good quality, patient oriented evidence. Receiving an “A” rating was the use of acupuncture for low back pain, neck pain, chronic idiopathic headache, and migraine headache. Inconsistent or limited quality studies or a “B” rating was received for shoulder pain, knee osteoarthritis, and fibromyalgia.

Basic Science: There is ongoing research to help understand how acupuncture works and why it is helpful. In animal models that received acupuncture, a spike in endorphin release in the CNS was noted. Cadaver models helped show that the majority of acupuncture points are located at junctions of muscles, tendons, and bones in areas that are rich in neural structures and interstitial connective tissue. This interconnected web of fascia that runs through the entire body is postulated to be a potential source of acupuncture’s mechanism of action. A new imaging test, function MRI or fMRI, helps show changes in cerebral blood flow to certain portions of the brain after acupuncture needle stimulation. All of these findings are pieces to a complex puzzle that is still being researched.

What next?: For some of you, the choice to refer someone for a treatment that you do not understand is difficult. I would suggest starting with a motivated patient that is open to thinking a little out-of-the-box. Many are more accepting if the practitioner is a physician and the office is professional. I would start with a patient who has a condition for which there is evidence (low back pain or migraines) who has failed traditional therapies such as medication, PT, injections, and is not a surgical candidate or the patient is hoping to avoid surgery. Acupuncture is extremely safe (3% experience bruising or needle pain with no major complications) and effective in many cases as is proven in the literature. As you gain comfort with recommending this treatment, it may enter into your discussions earlier if you start to see patients getting better.

Please feel free to contact me directly for any questions about acupuncture or a specific patient.

Pertinent Articles:

  1. National Institutes of Health. NIH Concensus Statement: acupuncture, 1997.
  2. Haake M, Muller HH, Schade-Brittinger C, et al. German Acupuncture Trials (GERAC) for Chronic Low Back Pain; Arch Intern Med. 2007;167(17):1892-1898.
  3. Linde K, Allais G, Brinkhaus B, Vickers A, White AR. Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev 2009; (1) CD001218.
  4. Berman BM, Lao L, Langenberg P, Lee WL, Giplin AM, Hochberg MC. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med. 2004;141(12):901-910.

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