HEALTHCARE
May 30, 2012

Acupuncture's Mixed Record

It's hard to know what to believe when it comes to alternative medical practices.

Alternative medical practices seem to be gaining speed as they maneuver into our collective health consciousness, but it is often hard for the public to know what to make of them. More major medical centers are offering non-conventional therapies to their patients. But many people may still be wondering, how effective are they?

The confusion about alternative practices is understandable. From acupuncture to yoga, there are a wide variety of methods available and the medical conditions that drive people to seek alternative medical practices are equally varied.

Whatever your reason for considering complementary and alternative medicine, you want to be somewhat skeptical, both because you should be interested in knowing what has been proven to work and because you need to know what is safe.

In addition, research into how these practices actually work on our bodies physiologically is still in its infancy – and the findings we do have are not always conclusive.

When is Medicine Alternative, Integrative, Complementary?

Alternative medicine means that alternative, Eastern, or non-conventional practices are used in place of Western or allopathic medicine. Complementary medicine uses both alternative and conventional practices in tandem. Integrative medicine is similar to complementary medicine, with the caveat that only techniques with solid empirical evidence are used in conjunction with conventional methods.

The NIH’s National Center for Complementary and Alternative Medicine (NCCAM), favors the term “CAM,” which includes both complementary and alternative medicine. There are four main divisions of CAM: Mind-Body medicine, including acupuncture, meditation, and yoga; Natural Products, which includes herbs and nutritional supplements; Manipulative and Body-Based Practices like massage and spinal manipulation; and “Other Practices” like Reiki, magnet therapy, and Ayurvedic medicine.

Because pain is both physical and mental, it is an excellent candidate to address with mind-body practice.

People turn to CAM for a variety of reasons. Some may be eager to try alternative techniques either because conventional medicine has not worked for a specific condition, or because they wish to avoid medication. Some simply use alternative methods in hopes of improving health and staving off disease.

But whatever your reason for considering complementary and alternative medicine, you want to be somewhat skeptical, both because you should be interested in knowing what has been proven to work and because you need to know what is safe.

Looking at the hard, scientific evidence may reduce the concerns people have about the safety and effectiveness of particular methods, though research on many of the methods discussed below is ongoing. In this series, we’ll focus on the better-studied and more familiar techniques that make up Mind-Body medicine. In this first segment, we look at acupuncture. Two subsequent segments will consider meditation, and yoga. We’ll go over the more promising data on each of these methods, pointing out the places where the research does and does not seem to support the claims. While some of the practices are still poorly understood, there are cases in which they do seem to have some real value – so giving them a try under certain circumstances (and an expert’s supervision) won’t hurt, and might actually help.

Acupuncture

This ancient practice is one of the most popular, but one of the most elusive. Dating back 5,000 years, acupuncture is still an important part of medical practice in China where it originated, and in the West, which has adopted it. Surveys have shown, for example that in 2007, approximately 3.1 million Americans had acupuncture in the previous year – this number had tripled from 1997.

According to the director of NCCAM, Josephine M. Briggs, MD, the most promising applications of acupuncture are in pain management, and much research has been devoted to understanding if and when it is effective. Because pain is both physical and mental, it is an excellent candidate to address with mind-body practice.

How Acupuncture Appears to Affect Our Perception of Pain
Knowing what’s going on in the brain can clue us into how acupuncture may help alleviate pain. Some of the more successful studies on the use of acupuncture in pain management involve studying the regions involved in the perception and memory of pain. When researchers use fMRI and PET scans to look at the brains of participants who were given a painful heat stimulus (a minor burn) and then gave the subjects The participants were actually given acupuncture while their brains were being scanned, so that the team could gauge its immediate effects.

In the brains of people who had undergone actual acupuncture, there were increased connections between the brain’s resting state network (default mode network, or DMN) and the areas that govern pain and handle memory.

The researchers saw changes in key areas of the brain, one area important in the perception of pain, and the other involved in governing how pain signals are transmitted through the body, which suggests that acupuncture may affect how the brain processes and responds to the pain signal.

Some have suggested that acupuncture’s effects are actually more pronounced not during, but following treatment. To address this possibility, another team looked at the brains of people who had undergone either actual or sham acupuncture five minutes prior to MRI scanning. They found that that in the brains of people who had undergone actual acupuncture, there were increased connections between the brain’s resting state network (default mode network, or DMN) and the areas that govern pain and handle memory. These results may suggest that the resting network of the brain (and its connection to other areas) continues to be effected after acupuncture ends.

There has been other evidence suggesting that acupuncture works on the brain’s opioid system, which is a large component of the brain’s pain response. Morphine, a potent painkiller, is a type of opioid. A study showing that patients receiving acupuncture were over twice as likely to successfully stop using morphine may support that idea.

Is Acupuncture Better than Placebo?
Such studies illustrate that acupuncture may have some effect on the brain’s pain response, including the opioid system. But other studies have not been so positive. One found that while acupuncture had a significant impact on back pain, compared to usual care, it was still no greater than simulated acupuncture, in which the needles do not penetrate the skin.

Another large review study found that while acupuncture had significant benefits on low back pain compared to Placebo immediately following the treatment. The effects did not last after that. In the same study, acupuncture and sham treatment (skin pricks with toothpicks, but no needles inserted subcutaneously) did not differ in helping neck pain, but they were better than no treatment at all. Acupuncture's effect on migraine pain has been similarly mixed, with some studies finding that acupuncture does seem to have an effect on migraine treatment and even prevention, but that it does not appear to be greater than sham.

Acupuncture and the Mind-Body Connection
Why is this? A likely reason is that acupuncture helps reduce the perception of pain. The perception of pain has been shown to be greatly affected by psychological factors, like anxiety, fear, and our own attention to it. Consider how children can “forget” about a tummy ache just by focusing their attention on something else – and adults are much the same way.

'Our minds and bodies are intimately connected, so there’s reason to think that if you’re reassured that you’ll feel better, this will change your perception of pain.'

Dr. Briggs says that part of acupuncture’s effectiveness may have to do with simply being distracted from one’s pain and being reassured by another that we’ll feel better. “Our minds and bodies are intimately connected,” she says, “so there’s reason to think that if you’re reassured that you’ll feel better, this will change your perception of pain.”

The bottom line seems to be that acupuncture may have some effect in reducing pain, but the mechanisms aren’t well demonstrated, and much of it may have to do with alleviating our perception of pain.

Still, says Dr. Briggs, “We’re learning more and more about acupuncture and the central nervous system, and there is a lot of excitement surrounding the use of neuro-imaging studies, like fMRI... We are also interested in real world effectiveness: does it help the healthcare system deal with tough problems like pain conditions that result in prescription abuse?” If acupuncture has even the slightest chance of reducing reliance on medication, this could save money, resources, and the risk of addiction.

Since acupuncture is typically safe and there’s little evidence that acupuncture can hurt you, says Dr. Briggs, it might be worth a try. If you do decide to try the practice, make sure you go to a trained professional who uses aseptic practices (for example, using disposable needles rather than reusable ones). See the NCCAM website for more information on choosing a practitioner.

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