In some respects, James Reston, a journalist for The New York Times, put acupuncture on the map of postmodern western consciousness. Many Americans remember that Reston traveled to China in 1971 with President Nixon’s secretary of state, Henry A. Kissinger.

While in China, Reston fell ill and ended up in a Beijing hospital, where he had an emergency appendectomy. What was striking is that he was treated with acupuncture postoperatively as a means of pain management. His article in the Times describing his experience was the first in-depth look many Americans had at acupuncture treatment.1


Background


Historians date the origin of acupuncture in East Asian medicine to the first or second century B.C. Acupuncture deals with keeping the body and its internal forces in harmony. As the practice was refined, actual conduits, or meridians, were identified along specific anatomical points. These meridians were thought to control the flow of energy balance.2

In North America, The National Institutes of Health noted that there is enough scientific evidence of acupuncture’s efficacy to warrant its use in certain clinical situations.2

Science


Acupuncture is a standard therapy used in Chinese medicine. It involves the use of sharp, thin needles that are inserted into the body at meridian points. By using meridian points, the qi — or vital energy and life force in eastern philosophy — is harnessed to control the flow of energy. Acupuncture is believed to adjust and alter the body’s energy flow into healthier patterns, and is used to treat a wide variety of illnesses and health conditions. 


Acupuncturists use very fine sterile, disposable, stainless steel needles (0.18-0.51 mm) with the upper part of the needle shaft covered in plastic to give the practitioner a handle of sorts.3 The actual depth of insertion and choice of trigger points along the meridians, or energy pathways, is determined at the discretion of the individual practitioner.4

Although ancient acupuncturists had no way of understanding the biochemical actions of acupuncture, recent researchers have postulated a mechanism of action. In many scientific papers discussing the methodology of acupuncture, the needling is thought to stimulate fine nerve endings that, in turn, activate endogenous monoamines and neuropeptides.2,5,6 Research shows that this system prompts the activation of electromagnetic signals that may direct immune cells and other neurohormones to the area of injury.2,5,6

In a meta-analysis, researchers noted that the majority of reviews considering acupuncture showed positive impacts on pain reduction in a variety of conditions.The most persistent positive outcomes were in the management of chronic low back pain and osteoarthritis.7

Multiple other conditions have shown mixed results in multiple clinical trials. Asthma, fibromyalgia, migraines, postoperative nausea and vomiting, and temporomandibular joint syndrome are on the lengthy list of conditions that may or may not be alleviated by acupuncture.7 The American Academy of Medical Acupuncture, however, expands significantly the number of conditions that may benefit from acupuncture therapy, including not only those listed but at least 31 others.2

A significant trial conducted in London examined 80 clients of general-practice clinics who were considered frequent patients with medically unexplained physical symptoms.8 These patients were randomized to receive 12 sessions of acupuncture starting either immediately or after six months.8

At the end of the acupuncture course, scores on a standardized medical-outcomes profile for those who received immediate treatment exceeded those recorded in the delayed-treatment group.8 However, at the end of one year, the delayed-treatment group’s scores had risen to nearly the same as the immediate-treatment cohort, indicating the positive impact of adding the acupuncture therapy.8

Safety, interactions


Typically, acupuncture is perceived to carry a low risk for adverse events. However, the risk of infection is always present when a foreign object is being inserted into the body. 


Such minor side effects of acupuncture as needle-site pain and bleeding occur in up to 11% of cases.9,10 In rare cases, serious adverse events do occur. Pneumothorax and cardiac tamponade were noted in studies, as were hepatitis C and HIV infection.9,10 The risk for hepatitis and HIV, 
however, were directly correlated to the individual acupuncturist.9,10

Cost


The costs of acupuncture can be very prohibitive, with the average charge for eight to 10 treatment sessions ranging from $600-$1,200.11

Summary


When administered by a properly trained professional, acupuncture is a safe and effective practice that may provide pain management in lieu of or in combination with more traditional therapy.

Sherril Sego, FNP-C, DNP, is a staff clinician at the VA Hospital in Kansas City, Mo., where she practices adult medicine and women’s health. She also teaches at the nursing schools of the University of Missouri and the University of Kansas.

References


1. Reston J. “Now, let me tell you about my appendectomy in Peking.” New York Times. July 26, 1971:1.


2. Braverman S. “Medical acupuncture review: Safety, 
efficacy, and treatment practices.” Medical Acupuncture. 2004;15:12-16.


3. Ernst E, Pittler M, Wider B, et al. “Acupuncture: 
its evidence-base is changing.” Am J Chinese Med. 2007;
35:21-28.


4. Dorsher P. “Can classical acupuncture points and trigger points be compared in the treatment of pain disorders? Birch’s analysis revisited.” J Alt Comp Med. 2008;14:353-359.


5. Goldman N, Chen M, Fujita T et al. “Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture.” Nat Neurosci. 2010;13:883-888.


6. Kavoussi B, Ross BE. “The neuroimmune basis of anti-
inflammatory acupuncture.” Integr Cancer Ther. 2007;6:251-257.


7. Ernst E. “Acupuncture: A critical analysis.” J Intern Med. 2006;259:125-137.


8. Paterson C, Taylor RS, Griffiths P et al. “Acupuncture 
for ‘frequent attenders’ with medically unexplained 
symptoms: a randomized controlled trial (CACTUS study).” Br J Gen Pract. 2011;61:e295-e305.


9. Ernst E, Lee MS, Choi TY. “Acupuncture: Does it 
alleviate pain and are there serious risks? A review of reviews.” Pain. 2011;152:755-764.


10. Witt CM, Pach D, Brinkhaus B et al. “Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form.” Forsch Komplementmed. 2009;16:91-97.


11. Cherkin DC, Sherman KJ, Avins AL et al. “A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain.” Arch Intern Med. 2009;169:858-866.