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Acupuncture is promoted as a treatment for pain--and there is absolutely no
question that it does in fact provide short-term benefit for many of the
people who try it. By some estimates, between 50 and 70 percent of patients
with chronic pain receive at least temporary relief when treated with
acupuncture, and some experience long-term relief as well.
However, doctors are still debating whether this type of therapy has any
effect beyond that of a placebo (a fake treatment with no real activity).
It's a difficult question to resolve because most placebos are actually
quite potent. Dummy pills typically achieve a relief rate of 30 to 35
percent, and a sham procedure, accompanied by suitably impressive
instruments and rituals, can be effective more than 50 percent of the time.
Indeed, in tests comparing genuine acupuncture with an imitation, patients
receiving the fake treatment usually enjoy just about as much relief (50
percent) as those given the real thing.
Of course, if your only concern is pain relief (as opposed to a cure of the
underlying problem), it doesn't really matter whether acupuncture's effects
are physical or merely psychological, as long as you feel better. And there
is, in any event, mounting proof of acupuncture's genuine value. According
to an expert consensus panel convened by the National Institutes of Health (NIH)
in 1997, well-performed scientific studies have provided evidence of
acupuncture's efficacy in relieving pain after dental surgery and in
reducing the nausea and vomiting associated with pregnancy ("morning
sickness"), chemotherapy, and anesthesia. Other research suggests that
acupuncture may be useful--along with other, more conventional
therapies--for asthma, osteoarthritis, low back pain, headache (both tension
and migraine), menstrual cramps, carpal tunnel syndrome, fibromyalgia, and
other conditions that cause chronic pain.
Two other intriguing areas are currently under research. One is the use of
acupuncture in easing withdrawal from addiction to hard drugs and alcohol;
acupuncture, especially of the outer ear, is in use at many detoxification
clinics in the United States. (Similar results have not been observed for
tobacco addiction, however.) Another possibility is that acupuncture therapy
may speed rehabilitation and limit damage after a paralyzing stroke.
How the Treatments Are Done
The "puncture" in
acupuncture refers to insertion of tiny needles at certain very specific
points on the surface of the body. The treatments vary widely, depending on
the individual practitioner and the style of acupuncture. There are several
"schools," including Chinese, Korean, Japanese, and a westernized version
(based on neurology, not Oriental medical philosophy) called trigger-point
therapy. Most practitioners of Oriental-style acupuncture perform at least a
partial physical examination at the first visit (including extensive
pulse-taking and, possibly, examination of the tongue and palpation of the
abdomen). They also tend to take a very detailed medical history, including
nutritional habits and other environmental factors.
The actual insertion of the hair-thin, disposable needles has been described
as feeling like a mosquito bite. After insertion, the needles may be
stimulated by twirling them or connecting them to a mild electrical current
(there is no risk of electrical shock). This stimulation may cause a mild
tingling or aching sensation referred to as "de qi." The needles may be
inserted from a fraction of an inch up to about one inch deep. They can
either be withdrawn a few seconds after insertion or kept in place for up to
30 minutes.
Treatment Time: Typically, you should allow 20 minutes to 1 hour per
session. The initial visit may take longer.
Treatment Frequency: This varies according to the problem. You may start out
with several treatments per week, then taper to weekly or less often.
Duration of therapy may range from a few treatments for acute, temporary
problems to regularly scheduled treatments over several months for chronic
conditions.
What Treatment Hopes to Accomplish
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Acupuncture has been
practiced in China for several thousand years, although this traditional
healing art didn't catch Americans' interest until the early 1970s, when a
Western reporter in Beijing received acupuncture for postoperative pain
(after undergoing an appendectomy under conventional general anesthesia).
How acupuncture works remains a mystery. According to ancient Chinese
medical theory, the life force (called qi or ch'i and pronounced "chee")
flows through the body via 14 invisible channels (called meridians),
regulating all physical and mental processes. Opposing forces within the
body, called yin and yang, must be balanced to keep ch'i flowing properly.
The meridians supposedly run deep within the body's tissues and organs,
surfacing at some 360 places identified as acupuncture points, sometimes
called acupoints. Certain meridians are identified with organs such as the
bladder or liver, and the points all along such meridians--even in the hands
or feet--are believed capable of affecting the associated internal organ.
Stimulating these points is said to balance and restore the flow of ch'i.
An explanation proposed by Western scientists is that acupuncture may
trigger the release of natural pain-killing substances within the body
called endorphins, thus blunting the perception of pain. It may also alter
the body's output of neurotransmitters such as serotonin and norepinephrine,
and of inflammation-causing substances such as prostaglandins. Like the
manipulation of ch'i, however, this explanation has yet to be conclusively
documented.
Whatever the cause may be, the pain-relieving effects of acupuncture seem to
have a delayed onset; they increase slowly, even after removal of the
needles, and may become more evident after several treatments. The effects
may diminish after acupuncture treatments are ended.
Who Should Avoid This Therapy?
In general, there are no medical conditions that rule out the use of
acupuncture except, perhaps, a morbid fear of needles. People at risk of
easy bruising or excessive bleeding (for example, patients with clotting
disorders and those taking a blood-thinning medication) would be prudent to
avoid acupuncture, since there is a slight risk of damage to blood vessels.
Pregnant women should avoid needle insertion on or near the abdomen.
What Side Effects May Occur?
Acupuncture has no inherent side effects. However, careless application of
the technique can present certain hazards. There have been documented cases
of hepatitis B transmission and serious bacterial infection due to
improperly sterilized needles, a problem that has been controlled by the
widespread use of disposable needles. Improperly performed acupuncture can
also cause bleeding (if a blood vessel is punctured) or injury to organs,
nerves, or tissue, making it important to find a skilled and reputable
practitioner.
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How to Choose a
Therapist
At least 35 states require some form of licensure or certification for the
practice of acupuncture. In unregulated states, acupuncture is technically
illegal unless performed by a physician, although this ban is rarely
enforced.
Educational requirements for licensure vary by state, and this regulatory
patchwork makes it difficult to judge an acupuncturist's credentials. Even
the titles vary; an acupuncturist may be "licensed," "certified," or
"registered," and in a few states may even have the title of "doctor" of
acupuncture or Oriental Medicine. Just to make matters more confusing, these
titles bear no consistent relationship to educational requirements, which
range from 1,300 to 2,600 hours of training (usually in an accredited school
or college of acupuncture). Surprisingly, the least qualified practitioners
may be physicians, who are permitted to practice acupuncture with no
training at all (although most have attended at least a few courses).
There are about 10,000 licensed, registered, or certified acupuncturists in
the U.S., and an additional 3,000 medical doctors (MDs) or doctors of
osteopathy (DOs) who practice the technique. To learn more about
qualification standards and practitioners in your state, contact the groups
listed under "Resources." Two of them may prove particularly helpful. The
Accreditation Commission for Acupuncture and Oriental Medicine sets
standards for acupuncture schools throughout the United States, and can send
you a list of accredited schools. The National Certification Commission for
Acupuncture and Oriental Medicine (NCCAOM) administers a standardized
examination testing theoretical and practical knowledge of acupuncture.
Those passing this test must meet continuing education requirements every
two years in order to retain certification. There are currently 5,000
practitioners who have achieved certification, and an increasing number of
states are using the examination as part of or acupuncture licensure. When
choosing a therapist, you should check to see whether he graduated from an
accredited school and whether he has received NCCAOM certification.
Unfortunately, no degree or license can reveal the most important variable:
skill and talent. Before undergoing treatment, you may also wish to learn
more about the practitioner's approach and philosophy. Some practitioners
combine acupuncture with other aspects of traditional Chinese medicine, such
as the use of traditional herbal remedies and the technique called
moxibustion (applying a smoldering cone of herbal material to the skin at an
acupuncture point). If your experience with one acupuncturist is negative,
remember that it's possible for a different practitioner to produce better
results.
When Should Treatment Stop?
According to the NIH panel, if you haven't obtained relief after 10 sessions
of acupuncture, the therapy isn't working and should be stopped. In general,
chronic pain relief should be perceptible after about six sessions if it's
going to happen at all; relief of conditions such as asthma tends to take
longer, sometimes months. A responsible acupuncturist will acknowledge when
treatment seems to be ineffective and won't pressure you to continue.
See a Conventional Doctor If...
Check with a doctor if you develop any symptoms that might signal a serious
illness. Even if traditional Chinese medical theory holds true, and
acupuncture has overall health-giving benefits, there are better treatments
available for many specific illnesses. Pain, whether chronic or acute, is a
red flag for countless medical conditions--some minor, some
life-threatening. Any new, persistent, or worsening pain should be evaluated
by a medical doctor before you seek relief through acupuncture.
Resources
ORGANIZATIONS National Commission for the Certification of Acupuncturists
and Oriental Medicine (NCCAOM)
1424 16th St., N.W., Suite 501
Washington, DC 20036
Phone: 202-232-1404
Internet: www.nccaom.org
This group provides certification for practitioners of acupuncture, Chinese
herbology, and Oriental bodywork therapy such as Shiatsu.
Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM)
Phone: 301-608-9680
This group sets standards for acupuncture schools and can provide a list of
accredited institutions.
American Academy of Medical Acupuncture (AAMA)
Phone: 800-521-2262
This is a telephone referral service for acupuncturists who are also medical
doctors.
American Association of Acupuncture and Oriental Medicine (AAAOM)
Phone: 610-266-1433
This group can provide nationwide referrals for licensed or registered
practitioners.
National Acupuncture and Oriental Medicine Alliance (NAOMA)
Phone: 253-851-6896
Internet: www.acuall.org
This group provides general information on acupuncture and referrals by mail
for state licensed or nationally certified acupuncturists.
FURTHER READING Between Heaven and Earth: A Guide to Chinese Medicine.
Harriet Beinfield and Efrem Korngold. New York: Ballantine Books, 1991.
Acupuncture: How it works, how it cures. Peter Firebrace and Sandra Hill.
New Canaan, CT: Keats Publishing Inc., 1994.
The Web That Has No Weaver. Ted Kaptchuk. New York: Congdon & Weed, 1983.
The Layman's Guide to Acupuncture. Yoshio Manaka. Weatherhill, 1972
Information resource: Yahoo Health News
http://health.yahoo.com/health/alternative_medicine/alternative_therapies/Acupuncture/
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