May 28, 2012
Does acupuncture have a point?

Acupuncture has been in use in traditional chinese medicine for over 2000 years. It involves inserting very thin needles into the skin at set ‘acupuncture points’. The traditional rationale for this was that it modified the flow of ‘Qi’ or ‘life energy. Whether or not you believe this mystical, magical explanation is entirely up to you, but I’m pretty sure it’s clear where I stand on subjects such as those. But - Acupuncture may work. When I first took a search of the published medical literature, the immediate response appears to be in favour of therapeutic effects of acupuncture especially in the treatment of the pain and nausea.

Modern clinics use a modified form of acupuncture known as electroacupuncture which uses electrically stimulated needles as opposed to the traditional ones. It appears that the effectiveness of the traditional acupuncture method is yet to be verified by science, but there is convincing evidence from many sources to support the case for electroacupuncture. The neurophysiological mechanisms by which it works are coming to light, and it may work in a manner similar to morphine. Experiments in both the clinical and laboratory setting have shown that naloxone, a blocker of the action of morphine and its relatives, reduces the beneficial effects of acupuncture. Diazepam (Valium) may also reduce the effects of acupuncture.

Electroacupuncture (Picture from The Physiotherapy Acupuncture Association of New Zealand)

Acupuncture, or at least electroacupuncture, may be stimulating the neural pathways ordinarily used in endorphin signalling. Endorphins have a role as the body’s natural painkillers, and are also released during pleasurable activities such as sex and exercise. Endorphins may also play a role in the placebo effect. Endorphins released from the hypothalamus act to dampen the activity of pain fibres ascending to the brain from the peripheral tissues (skin, internal organs etc). Morphine also acts on this pathway, but is much more potent, hence it’s painkilling properties. It appears that acupuncture may also be stimulating this pathway.

Attempts at ‘double-blind’ trials have been done, where one group of patients were administered acupuncture at the traditional acupuncture points, versus ‘sham’ acupuncture points, which were at random regions on the back. A major and obvious criticism of this is that it’s not really a placebo, but just a different method of stimulating the nerves. The patient still knows they’re receiving acupuncture and probably doesn’t know much about traditional acupuncture points anyway. A meta-analysis published in the BMJ by Madsen et al 2009 analysed 13 clinical trials (using a total of 3025 patients). It yeilded a very small difference between the effects of the two. There doesn’t seem to be anything special about the traditional acupuncture points, and indeed, ‘sham’ acupuncture also appears to have a beneficial effect at treating back pain. Once again, this could be down to some kind of placebo effect arising from patient expectation of having needles inserted into the back with effects toted to reduce pain.

Acupuncture appears to be helpful in some conditions, and more modern versions of acupuncture have a sound scientific basis of function. There isn’t much evidence to support it’s use in depression, anxiety or asthma but placebo or not, it’s role in reducing nausea and back pain is becoming rapidly more established.

(Hope this helps, nocountryforslaughter)

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