Acupuncture

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Treatment options, methods and evidence-based research on this ancient practice

What is it?

Although often offered as a separate therapy, acupuncture is in fact one of five which make up Traditional Chinese Medicine.

Acupuncture takes a number of forms including:

• Moxibustion;

• cupping;

• electro-acupuncture;

• auricular acupuncture;

• laser acupuncture;

• medical acupuncture;

• trigger point acupuncture;

• chakra acupuncture.

The aim of treatment is to rebalance disharmonies within the body, specifically the opposing elements of Yin and Yang, by harmonising the vital force, Qi within the body.

Disharmonies may be caused by internal factors such as the seven emotions (anger, joy, sadness, grief, pensiveness, fear and fright) or external factors such as wind, cold, damp, fire and heat.

Acupuncture treatment

Diagnosis is from examination and interview. Treatment involves the insertion of needles into specific acupuncture points (acupoints). These are identified along a meridian or meridians in order to remove blockages to, or rebalance the flow of, Qi to restore homeostasis.

The aim of the practitioner is to select the most appropriate acupuncture points singly or in combination to restore harmony and balance. Patients report a range of sensations such as peace, elation or relaxation.

A sensation called Deqi may be felt by the patient during an acupuncture treatment around the area of needle insertion. Deqi has been described as feelings of distension, aching, heaviness, tingling, warmth, numbness or soreness. The numb sensation is thought to be produced by the stimulation of large diameter A beta fibres and the heavy sensation by the stimulation of the large diameter A delta fibres (Pearce, 2000).

Where the use of needles is not appropriate or children are being treated, acupressure can be used. This involves the use of thumbs, fingers or elbow pressure over acupuncture points.

Acupuncture analgesia

This is of particular interest to nurses and is practised by some pain specialist nurses.

Analgesia is partially or wholly obtained by the insertion of acupuncture needles leading to the release of opioid-like endorphins and related neurohormones, which inhibit or modify the transmission of pain signals.

Neurotransmitters involved include:

• Dopamine;

• Noradrenalin;

• Somatostatin;

• Serotonin.

Treatment may be augmented by the use of electrically charged needles.

Response to this form of acupuncture is variable - it works for some people and not for others. Like other analgesic regimens it may have an immediate effect but more often will have an accumulative effect, and is said to be comparable to the administration of 33% nitrous oxide (Wilson,1997).

Evidence base

Some early randomised controlled trials into acupuncture were flawed because of the inappropriate use of 'sham' acupuncture as a control, resulting in unwarranted negative reports.

A number of clinical trials support the use of acupuncture in a range of conditions including:

• Migraine (Zhang, 2006);

• dysmenorrhea (Lorno et al, 2008);

• analgesia (Audette and Ryan, 2004; Zhang 2006);

• depression and anxiety (Kim, 2007; Pilkington et al, 2007);

• Nausea and vomiting in relation to motion sickness, chemotherapy (Dibble et al, 2007;

• Melchart et al, 2006; Molassiotis et al, 2007;);

• Post-operative vomiting (Arnberger et al, 2007);

• Addictions (Zhang et al, 2007).

Safety

Acupuncture should be used with caution in patients with bleeding disorders or those on anticoagulants. It may enhance the effect of any drugs already being taken, particularly if these include analgesia containing codeine.

Electro-acupuncture should not be used on patients with demand pacemakers. There have been instances of trauma such as pneumothorax reported following acupuncture (Barrett et al, 2007) but used by qualified therapists it is generally safe (Qu et al, 2006; White, 2006).

Training

A number of courses are available in acupuncture - either stand-alone or in conjunction with training in Traditional Chinese Medicine. Courses vary in standard and care should be taken in choosing them. Some courses in acupuncture analgesia are available. Contact the British Acupuncture Council www.acupuncture.org for a list of accredited institutions

References

Arnberger, M. et al (2007) Monitoring of neuromuscular blockade at the P6 acupuncture point reduces the incidence of postoperative nausea and vomiting. Anesthesiology;107: 6, 903-908.

Audette, J., Ryan, A. (2004) The role of acupuncture in pain management. Physical Rehabilitation Clinics North America; 15: 4, 749-772.

Barrett, S. et al (2007) Pneumothorax following acupuncture. British Journal of Hospital Medicine; 68:12, 677.

Dibble, S. et al (2007) Acupressure for chemotherapy induced nausea and vomiting : a randomised clinical trial. Oncology Nursing Forum; 34:4, 813-820.

Lorno, V. et al (2008) Acupuncture treatment of dysmenorrhea resistant to conventional medical treatment. Evidence-based Complementary and Alternative Medicine; 5: 2, 227-230.

Kim, Y. (2007) The effectiveness of acupuncture for treating depression: a review. Alternative Complementary Therapies; 13: 3, 129-131.

Melchart, D. et al (2006) Acupuncture and acupressure for the prevention of chemotherapy-induced nausea-randomised cross over pilot study. Support Care Cancer; 14:8, 878-882.

Molassiotis, A. et al (2007) The effect of P-6 acupressure in the prophylaxis of chemotherapy-related nausea and vomiting in breast cancer patients. Complementary Therapies Medicine; 15: 1, 3-12.

Pearce, L. (2000) Acupuncture and related therapies . In: Charman, R. (ed) Complementary Therapies for Physical Therapies, Edinburgh: Churchill Livingstone.

Pilkington, K. et al (2007) Acupuncture for anxiety and anxiety disorders a systematic literature review. Acupuncture Medicine; 25: 1-2, 1-10.

Qu, F. et al (2006) Prevention and management of potential accidents in acupuncture. International Journal of Clinical Acupuncture; 15: 30, 193-198.

White, A. (2006) The safety of acupuncture, evidence from the UK. Acupuncture Medicine; 24: Suppl 1, 53-57.

Wilson, O. (1997) Biophysical modelling of the physiology of acupuncture. Journal of Alternative and Complementary Medicine; 3: Suppl: s25-39.

Zhang, J. et al (2007) A survey on acupuncture for giving up heroin and treatment of the withdrawal syndrome. Journal of Traditional Chinese Medicine; 27: 2, 153-157.

Zhang, Y. et al (2006) The therapeutic effect of acupuncture and western medicine in treating migraine. International Journal of Clinical Acupuncture; 15: 3, 159-161.

Further reading

Birch, S., Felt, R. (1999) Understanding Acupuncture. Edinburgh: Churchill Livingstone.

Ernst, E., White, A. (1999) Acupuncture: A Scientific Appraisal. Oxford: Butterworth Heinemman.

Filshie, J., White, A. (1998) Medical Acupuncture. Edinburgh: Churchill Livingstone.

Useful websites

British Acupuncture Council (BAcC)  www.acupuncture.org.uk

British Medical Acupuncture Society (BMAS) www.medical-acupuncture.co.uk

Acupuncture Association of Chartered Physiotherapists (AACP) www.aacp.uk.com