Back Pain

Thus far, research has not produced convincing evidence that acupuncture is effective for back pain. Many studies widely cited as providing such evidence were actually invalid due to lack of a proper control group.163-164 There is no doubt that people with back pain given acupuncture report benefits, but the problem is that people given fake acupuncture also experience benefits, often to a similar degree.

For example, in a single-blind, no-treatment– and sham-controlled trial of 113 people with back pain, 20 sessions of traditional acupuncture generally failed to produce significantly more benefit than sham acupuncture.58 Both sham and real acupuncture, however, were far more effective than no treatment, demonstrating once again the placebo power of acupuncture.

Also, in a single-blind, placebo-controlled crossover trial of 77 people with chronic low back pain, again no significant difference was seen between the real acupuncture and placebo groups.81 (The study authors called their study "double blind," but in reality it was only observer-blinded.) A single-blind, placebo-controlled trial of 30 participants also found no evidence of comparative benefit.82

A trial compared the effects of acupuncture, massage, and education (such as videotapes on back care, etc.) in 262 people with chronic back pain over a 10-week period.83 The exact type of acupuncture and massage was left to practitioners, but only 10 visits were permitted. At the 10-week point, evaluations showed benefit with massage but not with acupuncture. One year later, massage and education were nearly equivalent, and both were superior to acupuncture.

One small study found chiropractic spinal manipulation more effective than anti-inflammatory medication or acupuncture for low back pain.165

In another trial, acupressure-style massage was found to be more effective for back pain than Swedish massage.84 However, Swedish massage has not been proven effective for back pain, so this does not prove that acupressure-style massage is effective.

Two single-blind, placebo-controlled trials, one with 30 participants and another with 60, also failed to find evidence of benefit.85,86

Two studies did find possible slight benefits with electrical acupuncture for chronic low back pain.166-167 Another study found acupressure more effective than physical therapy for low back pain,168 and another found some potential benefit with electric acupuncture.

Several other studies have compared acupuncture to other treatments for back pain, such as TENS, physical therapy, and chiropractic care, and found them equally effective.87–91 However, because TENS, physical therapy, and chiropractic care have not been proven effective for back pain, studies of this type cannot be taken as evidence that acupuncture is effective.

Stroke

Acupuncture is widely used in China for treatment of acute stroke. A few controlled studies have been published over the last 10 years, but the best-designed and largest studies failed to find benefit.169,97,127,98-101

For example, a single-blind, placebo-controlled trial of 104 people who had just experienced a stroke failed to find any benefit with 10 weeks of twice-weekly acupuncture.97

Similarly, a single-blind, controlled study of 150 people recovering from stroke compared acupuncture (including electroacupuncture), high-intensity muscle stimulation, and sham treatment. All participants received 20 treatments over a 10-week period. Neither acupuncture nor muscle stimulation produced any benefits.114 A 10-week study of 106 people, which provided a total of 35 traditional acupuncture sessions, also failed to find benefit.127

A few studies did find benefit, but they were very small and some did not use a placebo group.98-101

Other Studied Uses

Acupressure and acupuncture have been tried for insomnia, with mixed results. A single-blind, placebo-controlled study involving 84 nursing home residents found that real acupressure was superior to sham acupressure for improving sleep quality.32 Treated participants fell asleep faster and slept more soundly. Another single-blind, controlled study reported benefits with acupuncture, but failed to include a proper statistical analysis of the results.33 For this reason, no conclusions can be drawn from the report. In a third study, 98 people with severe kidney disease were divided into three groups: no extra treatment, 12 sessions of fake acupressure (not using actual acupuncture points), and 12 sessions of real acupressure.5 Participants receiving real acupressure experienced significantly improved sleep as compared to those receiving no extra treatment. However, fake acupressure was just as effective as real acupressure. In one study, magnetic pearls used to stimulate acupuncture points in the ear seemed to show some benefit as compared to nonmagnetic stimulation of ear points.170

One small double-blind, placebo-controlled study found real acupuncture more effective than sham acupuncture for menstrual pain.35 (This study used nonacupuncturists given real or fake acupuncture protocols to apply, unbeknownst to them.) In addition, a controlled study of 61 women evaluated the effects of a special garment designed to stimulate acupuncture points related to menstrual pain.76 Unfortunately, in this latter study, researchers chose to compare treatment to no treatment, rather than to sham treatment. For this reason, the results (which were positive) mean little.

Although anesthesia apparently performed entirely with acupuncture first raised Western interest in acupuncture, the original demonstrations of acupuncture anesthesia have been discredited. It now appears that if acupuncture has any anesthetic effect, it is extremely modest, at most capable of slightly decreasing the required dose of general anesthetic necessary to induce anesthesia (but even this has not been consistently seen in studies).171-172 One double-blind study failed to find electroacupuncture effective for reducing anesthesia requirements during surgery.173

One study found possible marginal benefit with acupuncture and moxibustion for the treatment of Crohn's disease.174

A 6-month, single-blind, controlled study of 67 women with frequent bladder infections found that acupuncture therapy reduced the frequency of infection.34

A study of 52 people with allergic rhinitis (hay fever) found that acupuncture plus Traditional Chinese herbal treatment was slightly more effective than fake acupuncture plus fake Chinese herbal treatment.175 However, another study failed to find acupuncture alone beneficial for allergic rhinitis.176

A Chinese study found that acupuncture plus moxibustion was more effective for Bell's palsy than drug treatment.177

A review of acupuncture for fibromyalgia found three controlled studies, only one of which was of adequate quality.36 This trial enrolled 70 people and followed them for 3 weeks37; some evidence of benefit was seen. A subsequent study (published only in abstract form) also found acupuncture effective for fibromyalgia when used in combination with standard therapy.110

Two small controlled studies found preliminary evidence that acupuncture can improve menopausal symptoms.128,178 Another study failed to find benefits with electroacupuncture.179

A sham-acupuncture controlled trial evaluated 43 people with depression and 13 with generalized anxiety disorder.80 The results suggest that 10 (but not 5) acupuncture sessions can significantly improve symptoms.

Another trial compared real and sham ear acupuncture in healthy people and found some evidence that real acupuncture can relieve normal daily stress.111

A small study found acupuncture more effective than sham acupuncture for impotence.180

Acupuncture has been explored as a means of reducing pain after surgery, but there have been more negative than positive results. A double-blind, placebo-controlled study of 42 people undergoing arthroscopic knee surgery found that the use of acupuncture during surgery did not reduce pain levels during the subsequent 24 hours.54 Another double-blind, placebo-controlled trial of 50 women undergoing hysterectomy found no benefit with electroacupuncture,55 and a double-blind study of 71 people undergoing abdominal surgery failed to to find acupressure helpful.60 However, some benefits of acupressure were reported in a single-blind trial of 40 patients undergoing arthroscopic knee surgery.56 In addition, a special form of needle insertion called intradermal acupuncture reduced postsurgical pain in 107 people undergoing abdominal surgery.38

Acupuncture may be as effective as standard treatments for TMJ.52 For example, a study of 110 people with TMJ pain found acupuncture at least as effective as standard occlusal splint therapy.53

Although acupuncture is widely used for weight loss, two out of three published studies failed to find it effective.112,113,116

A single-blind trial tested acupuncture on a group of 36 healthy young men and found some evidence of improvement in sports performance.95 However, a single-blind, controlled study of 48 people found that use of acupuncture did not reduce muscle soreness caused by exercise.105

Although case reports suggest that acupuncture might be helpful for psoriasis,135 a controlled trial failed to find acupuncture more effective than fake acupuncture.136

One study purportedly found that acupressure reduced fatigue in people with severe kidney disease.181 In fact, however, it found that both sham acupuncture and real acupuncture reduced fatigue as compared to no treatment but that real acupuncture was not more effective than fake acupuncture.

One study found minimal benefits for Parkinson’s disease.182

After an acute attack of shingles, pain may linger for months or years, causing what is known as post-herpetic neuralgia. A single-blind, placebo-controlled study of 62 people with pain of this type failed to find any benefit with acupuncture.94

A double-blind, placebo-controlled study tested the effect of single-point acupuncture versus placebo acupuncture in 56 people with rheumatoid arthritis.93 There was no difference in results between the real treatment and placebo groups. However, using a single acupuncture point to treat a complex disease such as rheumatoid arthritis must be regarded as highly questionable; normally, acupuncture for such a complex condition would involve many needles.

There have been numerous reports about acupuncture treatment for asthma,57,61 but most published studies are of low quality, and the results have been contradictory at best.62,63,183

Peripheral neuropathy (nerve pain in the extremities) is a common complaint in HIV infection. A placebo-controlled trial of 239 people with HIV found acupuncture no more effective than placebo in peripheral neuropathy.92 Interestingly, the study also tested drug therapy for peripheral neuropathy and found it ineffective as well.

A single-blind, controlled trial of individualized acupuncture for 34 people with severe epilepsy found no benefit.96

One controlled study failed to find electroacupuncture effective for reducing discomfort during colonoscopy.25

A controlled study purportedly found acupuncture helpful for speeding recover in people with spinal cord injuries, but it failed to use a sham-acupuncture control group.22

Several controlled and open trials of acupuncture for tinnitus (ringing in the ear) found no benefit.102,103

A well-designed, single-blind, placebo-controlled study of 60 people with irritable bowel syndrome compared traditional acupuncture to sham acupuncture.51 Over the 13-week study period, both groups improved to the same extent. A smaller and much shorter trial also failed to find benefit.115

In a placebo-controlled trial, 60 nursing women received needle acupuncture, 56 women received laser acupuncture, and 60 women received placebo acupuncture.104 The results showed no differences in milk production.

What to Expect During an Acupuncture Treatment

Acupuncture therapy has its own style and atmosphere, both like and unlike an ordinary medical encounter. Your first session will begin with a thorough analysis of your condition and health history. If the acupuncturist practices according to the principles of TCM, you will be asked a number of questions about your specific complaint and your general health, including how well you sleep, digest your food, eliminate, and breathe; your energy level; and so forth. All of these factors are considered relevant. The acupuncturist may ask questions that seem to have little bearing on your condition, such as, "Do you tend to feel cold or hot most of the time?" TCM looks for overall patterns in both physical and emotional well-being, which guide the acupuncturist in developing a treatment plan that is specific not only for your symptoms, but for your overall health pattern.

Depending on your specific complaint and your individual symptom pattern, the acupuncturist may use only a few needles or as many as 20 or more. Acupuncture needle sizes are typically 32- to 36-gauge, which means they are about ¼ mm in diameter, much smaller than a hypodermic needle. Unlike hollow hypodermic needles, acupuncture needles are solid, which allows them to penetrate the skin easily and relatively painlessly. Acupuncture needles may produce a mild pricking sensation when inserted, but sometimes you will feel nothing at all as the needle is inserted. The needles are generally inserted to a depth ranging from a few millimeters to ½ inch or so. Insertion depth is deeper at the more fleshy areas of the body, such as the thighs and buttocks.

Acupuncture needles are typically inserted through a plastic tube that guides the needle into the skin. This is a fairly modern needle insertion technique. Traditional freehand insertion is also used; most acupuncturists are trained in this method. Virtually all acupuncturists in the United States now use pre-sterilized, one-time-use disposable needles, which eliminates any risk of cross-infection.

The acupuncturist may twirl the inserted needles and ask you to say when you feel a mild achy, heavy sensation; or, the area may feel slightly numb or tingly. These sensations, described in TCM as the arrival of Qi, are regarded as a positive response that will enhance the effectiveness of the treatment.

Whatever you feel, the sensation should be mild, not overly unpleasant, and should subside within a few minutes. If any needles are genuinely painful, inform the practitioner so he or she can adjust the depth or remove the needle altogether. The needles are generally left in place for 20 to 30 minutes. During this time, you should feel comfortable and relaxed, and you may fall asleep.

Acupuncturists may also employ a technique known as electroacupuncture, in which electrodes are attached to the needles and a mild current is applied. This is intended to increase the stimulation of the needle and is generally used for more painful conditions. Electroacupuncture produces a tingly, pulsating sensation. The acupuncturist can control the intensity and adjust it to a level that is comfortable for you.

Traditionally trained acupuncturists often use heat as well as needles to stimulate acupuncture points with a procedure called moxibustion, which involves a mixture of herbs rolled into a cigar-like shape. The roll is lit, and the burning end is held over the skin, allowing the heat to penetrate the area around the acupressure point. The moxa roll never touches the skin, so you will not be burned. The acupuncturist will ask you to let him/her know before it gets too hot. Moxibustion is generally quite pleasant. It is regarded as a "tonifying" treatment, which means it is intended to strengthen function.

Safety Issues

Serious adverse effects associated with the use of acupuncture are rare.106-108 The most commonly reported problems include short-term pain from needle insertion, tiredness, and minor bleeding. There is one report of infection caused by acupuncture given to a person with diabetes.184

Some acupuncture points lie over the lungs, and insertion to excessive depth could conceivably cause a pneumothorax (punctured lung). Because acupuncturists are trained to avoid this complication, it is a rare occurrence.

A recent report from China contained an example of another complication caused by excessively deep needling.109 A 44-year-old man was needled on the back of the neck at a commonly used acupuncture point just below the bony protuberance at the base of the skull. However, the acupuncturist inserted the needle too deeply and punctured a blood vessel in the skull. The client developed a severe headache with nausea and vomiting; a CAT scan showed bleeding in the brain, and a spinal tap found a small amount of blood in the cerebrospinal fluid. The severe headache, along with neck stiffness, continued for 28 days. The man was treated with standard pain medication, and the condition resolved itself without any permanent effects.

Infection due to the use of unclean needles has been reported in the past, but the modern practice of using disposable sterile needles appears to have eliminated this risk.