Medical Acupuncture

Introduction to acupuncture
What happens at an acupuncture visit?
How does acupuncture work?
Adverse events associated with acupuncture

Introduction to acupuncture

Acupuncture is an element of traditional Chinese medicine practiced routinely in China, Japan, Korea and other Eastern countries. Over recent years there has been a growing demand for acupuncture and an acceptance of the technique among medical professionals. The practice of acupuncture is based on therapeutic insertion of solid needles in various combinations and patterns. Qi (pronounced chee) is a subtle vivifying energy and the traditional principle of acupuncture is to encourage the flow of qi in the body. Modern concepts of acupuncture include recruiting neuroanatomical activities in segmental distributions. Many practitioners who practice acupuncture use a combination of these two principles. Respect for acupuncture grew in the late 1970s when it was shown that acupuncture lead to changes in central nervous system activities of endogenous epioids and biogenic amines. For many people, acupuncture is an effective method of relieving pain.

What happens at an acupuncture visit?

An acupuncture visit usually begins with a history and examination of the tongue, face and pulse. During the visit, several needles are inserted and manipulated by hand or used to transmit electrical stimuli. Treatment for a single complaint continues for 6 to 12 sessions over several months, each visit lasting for half and hour. Acupuncture is primarily used to relieve pain.

How does acupuncture work?

Traditional explanation of acupuncture

Acupuncture needles Qi, or energy, is inherited at birth and maintained throughout life by intake of food and air, circulating throughout the body and providing nourishment. The major circulatory pathways are 12 meridians that form a continuous network, and more than 350 acupuncture points are located on these meridians. Health is then viewed as a balance of Yin and Yang, which are two opposites, and imbalance, disharmony or disturbance of these opposites leads to disease. The body can be stimulated to correct its own energy flow and balance through acupuncture.

Scientific explanation

Acupuncture points are sites where nerves can be stimulated, and acupuncture is a method of stimulating nerves and muscles. Acupuncture releases various neurotransmitters including endogenous opioids and serotonin, and administration of naloxone (an opioid antagonist) prevents acupuncture-associated analgesia. Acupuncture stimulates large, myelinated, rapidly conduction A-delta nerve fibres, which may decrease transmission of painful sensations of via slower, unmyelinated C fibres. It is also associated with a powerful placebo effect and if used responsibly, may benefit many patients with chronic pain.

Adverse events associated with acupuncture

Adverse events with acupuncture are rare, and are usually avoidable with adequate training and care during acupuncture treatments. To reduce the risk of adverse events, acupuncture is generally regarded as contraindicated in patients with severe bleeding disorders (needle acupuncture), pregnancy, cardiac pacemaker (acupuncture with electrical stimulation), and patients at risk from bacteraemia such as asplenic or neutropenic patients (indwelling needle acupuncture).

Serious adverse events

Cardiac trauma
Endocarditis
Hepatitis
Pneumothorax
Renal injury
Septicaemia
Spinal cord injury

Potentially serious adverse events

Bleeding (occurs in 3%)
Drowsiness (occurs in 1%)
Perichondritis
Peripheral nerve damage
Retained needle
Syncope

Non-serious adverse events

Contact dermatitis
Erythema
Local pain (occurs in 1%)
Aggravation of presenting symptom or reason for acupuncture

Conditions recommended for acupuncture by the World Health Organization

Respiratory: acute sinusitis, acute rhinitis, acute tonsillitis, common cold.
Bronchopulmonary: acute bronchitis, asthma.
Eye: acute conjunctivitis, cataract without complications, myopia, central retinitis.
Mouth: toothache, pain after tooth extraction, gingivitis, pharyngitis.
Orthopaedic: periarthritis humeroscapularis, tennis elbow, sciatica, low back pain, rheumatoid arthritis.
Gastrointestinal: oesophageal spasm, hiccoughs, gastroptosis, gastritis, gastric hyperacidity, chronic duodenal ulcer, ulcerative colitis, bacterial dysentery, constipation, diarrhoea, paralytic ileus.
Neurological: headache, migraine, trigeminal neuralgia, facial paralysis, paralysis after apoplectic fit, peripheral neuropathy, paralysis caused by poliomyelitis, menieres syndrome, neurogenic bladder dysfunction, nocturnal enuresis, intercostal neuralgia.

Reference

Ernst, E. Acupuncture for rheumatic conditions. UpToDate. 2006.
Frequently asked questions. American Academy of Medical Acupuncture. Available at: http://www.medicalacupuncture.org/acu_info/faqs.html
Helms, J. An overview of Medical Acupuncture. American Academy of Medical Acupuncture. Available at: http://www.medicalacupuncture.org/acu_info/articles/helmsarticle.html