What is acupuncture?
Acupuncture is part of the ancient Chinese medical system. It uses very fine needles inserted into specific acupuncture points to correct problems in the circulation of vital “materials”.
According to Chinese medicine, pain is caused by disturbed or imbalanced circulation of two of these vital materials in particular. These are the Qi (pronounced as Chee) and blood. The Qi and blood flow in channels networking the body. When the Qi is blocked somewhere, the pressure piles up in the local tissues and causes pain. The counterpoint to this is if the Qi is not reaching some part of the body, the fortification provided by the Qi is reduced and dysfunction is this area will produced pain. When a blockage is identified by Chinese medicine diagnosis, acupuncture points are selected to promote the flow of Qi in the channel, thereby breaking the blockage.
Acupuncture is now well recognised all over the world as the flagship of complimentary medicine. More and more patients choose acupuncture for a variety of clinical conditions. Pain management is the predominant reason for patients to seek acupuncture.
It is widely used in pain management in hospital, especially in pain clinics. According to a survey carried out in 2004, about 23% of all pain clinics in UK provide acupuncture treatment.
Acupuncture and pain relieve
Acupuncture can effectively manage the following types of pain:
· Headache/migraine
· Muscular-skeletal pain in neck, back and limbs
· Period pain
· Labour pain
· Pain in cancer
· Pain caused by Herpes zoster (shingles)
· Trigeminal neuralgia
· Sciatica
The pain-relief effect of acupuncture in the above conditions is well supported by more than 1000 published clinical reports and laboratory research reports.
More importantly, acupuncture can effectively treat cases which fail to respond to conventional interventions.
Acupuncture is Safe
Acupuncture safety has been continuously monitored by researchers since 1999 in western countries and 2 major UK national-wide investigations have been published. According to this research, adverse effects are rare. The total number of incidences, including the most minor, represents about 1-3 % of treatments. The most common adverse effects include: tiredness, disorientation, aching in the needled point and bluish, bleeding at the needled point. No serious damage has been reported in the last 5 years in the UK.
Character of acupuncture
Natural:
No medication or chemical materials are used. The needles are fine and solid, and made of pure stainless steel which is neither soluble nor chemically active.
Holistic:
Acupuncture treats the patient as a whole, not only the pain. Acupuncturists make their judgement based on the overall condition of the patient. They try to mobilize a patient’s own healing power to alleviate of the problem, assisting this process by removing the blockage in the local tissue or organ to reduce the pain.
Individualised treatment:
Each person has their own constitution, experience of pain, and understanding of life and disease. The cause may also differ. For the same pain, the acupuncturist’s choice of approach and acupuncture points may differ from person to person.
Effective:
The pain relieving effects of acupuncture have been proven by numerous scientific research studies and clinical trials.
How acupuncture is practised
There are two principal styles of acupuncture: western style and traditional Chinese style.
Modern style of acupuncture
Acupuncturist in this school use mainly local points to relieve the pain. These local points are referred to as Trigger points, Focal points, Tender points and Segmental points.
The methods of stimulating the points include: needling, laser, injection, TENs, static magnetic, and electric acupuncture.
Traditional style of acupuncture
Acupuncture points on meridians (channels) involved are chosen both locally and distally to the centre of pain. The meridians are a network system binding the body together, and the Qi and blood flow in this network. For example, a pain in the knee may originate in the back and be conducted by the channel connecting these locations.
The stimulation methods are mainly: needling, moxibustion, cupping, and pressure.
Needle sensation
Different sensations are perceived once the needle enters the point. They have been variously described as gripping, spreading, warm, tingling and many more.
The manipulations of needling
During an acupuncture session, the acupuncturist may manipulate the needle in any of the following ways:
· Gently moving the needle in an out (lifting and thrusting)
· Gently rotating the needle
· Gently scratching the handle of the needle, producing vibration
· Heating the needle with moxa
Scientific Validation of Acupuncture
After 40 years research, some of the secrets behind acupuncture have been revealed using modern science. The main discoveries relating to acupuncture concern: increasing endorphin levels in the brain; changes in the pattern of neurotransmitter response; re-shaping of the functional control of pain in the central nerve system; and neuro-signal communication control theory (gate-control theory and signal competing theory).
The endorphin finding reveals that when receiving acupuncture, the brain produces more endorphin which has a strong pain-blocking effect and can elevate the patient’s mood. The neurotransmitters finding tells us that when receiving acupuncture, the levels of some neurotransmitters such as Serotonin and Dopamine are increased in some parts of the nervous system, whilst levels of others are reduced in other parts. Thus the functionality of the nervous system can be re-shaped. Some parts become more active while other parts become less active. In this way, a new pattern of activity can be achieved, replacing the pattern associated with pain and illness. These conclusions are supported by laboratory research.
Furthermore, the conducting behaviour of nerves is thought to be modified by acupuncture. There are different types of nerve fibre. They work in different ways. Some transmit the signal very quick, others slowly. By stimulating specific fast fibres carrying low pain signals, the first arriving signals close the gate against slower signals which carry more serious pain. The signal carrying the serious pain is blocked and does not pass to the brain.
Clinical Validation of Acupuncture in Pain Management
Osteoarthritis
The following three papers report on trials which have been strictly designed following the best medical trial rules: randomised, controlled, and blinded. The results indicate that acupuncture works effectively on the clinical condition of osteoarthritis.
1. Vas J. et al (2004) Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomised controlled trial. British Medical Journal 2004:329 (7476):1216
2. Berman BM et al (2004) Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized controlled trial. Annals of Internal Medicine 2004: 141 (12): 901-10
3. Witt C et al (2005) Acupuncture in patients with osteoarthritis of the knee: a randomised trial. Lancet 2005; 366 (9480):100-1
Labour pain
Acupuncture in Managing Labour Pain – Norway
A randomized controlled clinical trial on 210 mothers in spontaneous labour has been carried out in Norway. The trial compared responses to acupuncture against those to false acupuncture. The researchers concluded that acupuncture not only reduced the amount of labour pain, it also reduced delivery time. It was particularly useful for those mothers preferring non-pharmacological pain-relief without side-effects. (Acta Obstet Gynecol Scand 2002 Oct; 81(10):943-8).
Acupuncture in Managing Labour Pain – Sweden
The study has found that women who received acupuncture during labour were less likely to ask for an epidural to relieve pain (12% compared to 22%) and felt more relaxed than women who did not receive acupuncture. The trial included 46 women were in the acupuncture group and 44 in the control group. The women in the acupuncture group were half as likely to request conventional methods for pain relief and feel more relaxed than the control group. (British Journal of Obstetrics and Gynaecology 2002;109:637-644).
Migraine
Acupuncture is highly recommended as the following extract indicates:
Acupuncture for migraine and tension-type headache
Acupuncture is helpful in treating chronic headaches, reported four newspapers on 15 March 2004. The reports accurately summarised a well-conducted trial on the effects of an acupuncture service in primary care. In the study, patients treated with acupuncture had fewer and less severe headaches and migraines than those who were not.
The newspaper articles were based on a randomised controlled trial, which investigated the effects of adding acupuncture to normal care in the primary care setting. The trial was conducted in twelve areas of England and Wales, recruited 401 patients and gave results for 301 patients (5). Patients treated with acupuncture had less severe headaches, took fewer days off work, used fewer medicines and made fewer visits to the doctor than did patients treated by standard care alone. However, patients treated with acupuncture still suffered from regular headaches and required regular pain-relieving medication.
The newspapers accurately reported the findings of the study. In addition three newspapers referred to a separate research study, which assessed the cost-effectiveness of acupuncture for headaches …
5. Vickers AJ, et al (2004) Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial. BMJ, doi:10.1136/bmj.38029.421863.EB (published 15 March 2004)
6. Melchart D, et al (2004) Acupuncture for idiopathic headache (Cochrane Review). In: The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.
7. Ezzo J, et al (2000) Is acupuncture effective for the treatment of chronic pain: a systematic review. Pain 2000;86:217-225.
8. Vernon H, et al (1999) Systematic review of randomized clinical trials of complementary/alternative therapies in the treatment of tension-type and cervicogenic headache. Complementary Therapies in Medicine 1999;7:142-155.
9. Manias P, Tagaris G, Karageorgiou K. Acupuncture in headache: a critical review. Clinical Journal of Pain 2000;16:334-339.
