When I decided to write about acupuncture, I started with a quick google search to find out what we know, and what are the mainstream understandings regarding the treatment. ‘Facts about acupuncture’ is what I wrote in the search box, as one would when one wants to find out the truth. The first five links that came up are mediocre quality blogs which explain in a basic way what acupuncture is, but give very little insights into the truth behind the matter. Good quality, relevant information is very hard to come by with the flooding of useless information on the internet. I hope this can help explain a bit about acupuncture, for those who consider spending good money to get treated.
A brief history of acupuncture
The history of acupuncture is incredibly fascinating. There is a great deal of information but this being a blog post and not a book, I will focus on the main points only. The tradition was said to have been invented around 8000 years ago in China, during the new stone age. Most of the volumes throughout history are based upon a text which describes a dialogue between an emperor and his physician, around 2600 years ago.
The earliest physical evidence that we have comes from a tomb dated back to 113 BCE. Throughout the modern era a number of more elaborate texts have been written, each more elaborate than the previous one. It appears that this became somewhat of a medical trademark during a Chinese emperor’s rule. The latest of these great works was written during the Ming Dynasty (early 1600s), consisting of 120 volumes. In this encyclopedia, titled Principles of Acupuncture and Moxibustion, new techniques are created, new acupuncture points are found, and new equipment is introduced. This is the textbook upon which most acupuncture practices in the western world are based upon.
Acupuncture’s journey to the United States is extremely recent along the timeline of history. In 1971 an article appeared in the New York Times, in which a reporter talked about his experience of an emergency operation, which he underwent in China, to remove his appendix, and his take on the acupuncture that was used to improve the analgesic effects. In 1997 JAMA (a peer reviewed scientific journal) published an article that opened the door to the possibility of evidence to support acupuncture treatment. The alternative medical treatment has gained momentum since, and continues to be a very popular treatment all over the world. In the US alone it was a multibillion dollar industry in 2016.
How does it work?
Acupuncture is a treatment in which very fine needles are inserted into specific points on your body. The points are chosen according to 14 defined energy channels that flow through the body.
The exact physiological mechanism of acupuncture is not known completely. Traditionally, the treatment is built on the belief that the body has a balance of energy, the Yin and the Yang. Some physicians have likened this to the sympathetic and parasympathetic systems of our body. When the body is sick or in pain, there is an imbalance of these energies, and acupuncture is an attempt to correct this balance.
What is it most commonly used to treat?
In the United States and Europe, acupuncture is mainly used for the treatment of chronic pain. This includes a variety of diseases including dental pain, fibromyalgia, knee osteoarthritis, chronic back pain, and an idiopathic headache. Other uses have also been suggested and include treating nausea/vomiting and insomnia. In China however, the two strongest indications for the treatment of acupuncture are Bell’s Palsy, and Cerebrovascular accidents (stroke for example).
What does the evidence say?
Acupuncture is one of the alternative medicine techniques that has been studied quite a bit, providing enough evidence to give us an initial understanding of the conclusions. Many articles that I have come across are quick to say that acupuncture has been proven to help and treat a number of diseases, though it’s important to read these studies with a skeptic eye. I will refer to here a few of the larger and more influential studies completed, and quickly review what they mean. If you (yes you, reading this article) know of a study that is larger, or more convincing please send to me through a comment, or on the Facebook page and I would be happy to have a look at it.
One of the important criteria that I want to mention when looking at studies, was to see if proper acupuncture was compared to sham acupuncture. Sham acupuncture is treatment in a similar setting, though instead of inserting needles into the body, they insert retractable needles. This is to create a psychological effect that you are undergoing treatment, without the true acupuncture treatment itself. This comparison, which is routinely used when testing new drugs, questions if the treatment has merit in it’s methods, or if the benefits are a result of the placebo effect.
Chronic pain: In 2012, a review of 29 different individual studies was published in JAMA, which included almost 18,000 participants and evaluated the efficacy of acupuncture in treating chronic pain. The study concluded that acupuncture helped improve pain quite significantly in patients suffering from back and neck pain, osteoarthritis, and chronic headaches, in comparison with no treatment at all. However when compared to sham acupuncture, the benefits were unconvincing, and modest at best. Drawing conclusions from reviews of a number of studies is beneficial in that we can see a much larger database of outcomes, however with the complexity and number of factors of each trial, it is very tough to accurately evaluate the answers as a whole.
The next study that I want to mention is considered the ‘largest randomized study of acupuncture ever done’. This study is often used by advocates of acupuncture as a strong piece of evidence proving the efficacy of acupuncture to treat headaches. People that had headaches for 8.4 days of the month on average by the end of the study only suffered from headaches 4.7 days of the month. This study has a number of significant flaws, that I want to mention. First of all, there was no comparison to sham acupuncture, and so the placebo effect cannot be ruled out for the outcome. In addition, there is no ‘blinding’ effect in the study, and all of the participants knew what they were getting, as well as those administering the treatment. This also prevents us from ruling out the placebo effect.
The study was conducted with more than 15,000 people suffering from headaches, however less than 3,500 agreed to randomization. The remaining participants were included in the study, with a label of being not-randomized. Even though this data is biased, it was included anyway. The data from this study is unable to attest to the fact that acupuncture is an effective treatment for headaches, and not just a strong mediator of the placebo effect. Similar claims as to the efficacy of acupuncture for treating insomnia are also based on studies that do not rule out the placebo effect.
A study which was conducted in an attempt to determine the effects of acupuncture on patients diagnosed with Parkinson Disease was published in 2002. This study included 20 people, and failed to come up with evidence supporting the benefits of acupuncture treatment, even as an added supplement to traditional treatment.
Lastly, I want to mention a study that looked at the treatment of acupuncture in patients suffering from peripheral joint osteoarthritis. Traditional medicine does not offer much to help these patients, waiting until the pain becomes unbearable and then offering surgery to replace the entire joint. In 2010 a systematic review of 16 randomized control trials, including almost 3500 patients suffering from osteoarthritis of the hip or knee was published. The study concluded that although there were short-term benefits in the patients who received acupuncture in comparison to those who received no treatment or sham acupuncture, this evidence did not hold true from 3 months later and afterwards. In addition the benefits were not considered significant by the threshold defined by this review. Results were extremely heterogeneous, and could not be easily deciphered by clear patterns. Studies that followed patients over 6 months showed results that were not statistically significant at that time.
To sum up, the evidence is quite convincing that the main benefits of acupuncture can be attributed to the placebo effect. For those reading who do not know what this is, I recommend you read up on it because this is a fascinating phenomenon. It’s important to mention that I am not concluding that acupuncture does not work, quite the opposite. It may be a very effective mediator of the placebo response, but on the other hand so can magic if you believe in it.
Can acupuncture be potentially dangerous?
Any and every treatment has it’s downsides. If somebody tells you that there are absolutely no risks or side effects, run as fast as you can. Acupuncture can be potentially dangerous, so it’s very important that if you choose to go through with this treatment it is with a trained professional who knows your medical history.
Most of the cases recording adverse effects of acupuncture are situations of malpractice, though some of these complications can be very severe. In the USA, 5 deaths were reported between 2000-2009, and other severe complications included organ trauma (pneumothorax being the most prominent), and infections. Spinal cord injury, and other neural diseases were reported as well.
Perhaps the most dangerous complication is neglecting traditional treatment for curable diseases. Too many cases in history of protective parents not letting their child undergo surgery or chemotherapy in types of cancer with very good prognosis are a good example of this. It’s important to see what treatment is available for the condition, what the evidence has to say about the treatment, and what are the risks of not undergoing treatment. As always, make sure to consult with a physician for medical advice. This blog is meant to provide insight and information, but not give specific medical advice. Make informed decisions.