Acupuncture Basics for Physicians

I am writing in an effort to promote a better understanding of acupuncture in the medical community.  According to the 2002 National Health Interview Survey, the largest and most comprehensive survey of complementary and alternative medicine, an estimated 8.2 million adults have used acupuncture. Furthermore, acupuncture currently has the highest rate of physician referral (43%) among all CAM therapies followed by chiropractic (40%) and massage (21%) (Arch Intern Med. 1998;158). But few physicians know how and when to use acupuncture as a referral.  When utilized effectively, acupuncture is a valuable conservative approach to pain, neuropathy, fatigue, insomnia and many internal disorders.

Is acupuncture effective?

Numerous randomized, controlled trials and more than 25 systematic reviews and meta-analyses have evaluated the efficacy of acupuncture.  The NIH has made the following statement:

Studies involving physiologic aspects of acupuncture have allowed physicians and acupuncturists to bridge the gap, connecting modern and Chinese medicine in ways more fully comprehensible:

• Acupuncture analgesia may be initiated by stimulation, in the muscles, of high-threshold, small-diameter nerves.  These nerves activate the spinal cord, brain stem (periaqueductal gray area), and hypothalamic (arcuate) neurons, which, in turn, trigger endogenous opioid mechanisms.  These responses include changes in plasma or corticospinal fluid levels of endogenous opioids (for example, endorphins and enkephalins) or stress-related hormones (for example, adrenocorticotropic hormone). (Pomeranz, et al. Scientific Bases of Acupuncture. New York: Springer-Verlag; 1989)
• Evidence also supports the possibility that one mechanism of acupuncture may be a form of stimulation for the gene expression of neuropeptides. (Guo, et al: Brain Res Mol Brain Res. 1996;43:167-73. Gao, et al: Acupunct Electrother Res. 1997;22:161-6)
• Acupuncture may inhibit early-phase vascular permeability, impair leukocyte adherence to vascular endothelium, and suppress exudative reaction  (Sun: International Journal of Chinese Medicine. 1984; 1:15-20)
• One study found that a specific acupuncture point, traditionally related to vision, activated an occipital lobe region that was the same area activated by stimulation of the eye using direct light as shown through fMRI.  The point was located on the lateral aspect of the foot; stimulation of nearby sham points did not result in similar activation.  (Cho, et al. Proc Natl Acad Sci U S A. 1998;95:2670-3)

Are acupuncturists properly trained?

Acupuncturists in California are some of the best trained in the country.  Programs such as Pacific College of Oriental Medicine in San Diego require almost four years postgraduate work comprising 3500 hours of study in acupuncture, Chinese herbology, diagnostic theory, biomedicine, safety, and integrative methods along with extensive clinical training.  Each year Chinese medicine programs are becoming more rigorous, incorporating more conventional physiology and practice and the growing pool of applicants allows schools to choose the very best for admission.

So, when should I think of acupuncture?

The answer to this question is constantly evolving among academics, researchers, and clinicians alike.  The following is a short representation of prevailing views within the Chinese medicine community and my own clinical insight.
Acupuncture is a viable option for patients when:

• Conservative therapy is still warranted, but conventional routes seem ineffective on their own.
• Drug side effects are cumbersome or dangerous
• Pre/Post-surgical recovery for which benefits to compliment system and local vasculature, decreases in exudate and pain, and rebalancing of musculature are warranted.
• Myofascial injury has occurred, a great complement for  meds, steroid injection, and PT
• Components exist that complicate case for which acupuncture has proven to regulate including levels of serotonin, endorphins, triglycerides, cholesterol, phospholipids and neurotransmitters as well as chronic inflammation, pain or postural  imbalance
• Research supports its use in a particular symptomology (see list below)