Pathways to healing: acupuncture effective in community-based medical practice.
Subject: Community health services (Services)
Acupuncture (Methods)
Acupuncture (Patient outcomes)
Acupuncture (Social aspects)
Pain (Care and treatment)
Pain (Methods)
Author: Zablocki, Elaine
Pub Date: 11/01/2011
Publication: Name: Townsend Letter Publisher: The Townsend Letter Group Audience: General; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 The Townsend Letter Group ISSN: 1940-5464
Issue: Date: Nov, 2011 Source Issue: 340
Topic: Event Code: 360 Services information; 290 Public affairs
Product: SIC Code: 8399 Social services, not elsewhere classified
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 271811620
Full Text: Acupuncture is winning broad recognition as an important way to treat pain. According to the 2007 National Health Interview Survey, which included a comprehensive survey of CAM usage, an estimated 3.1 million Americans (1.4% of respondents) said that they had used acupuncture during the past year. An earlier survey found that acupuncture is often used for pain or musculoskeletal complaints, most often for back pain, followed by joint pain, neck pain, severe headache/migraine, and recurring pain. The American College of Physicians, the American Pain Society, and the North American Spine Society have all developed standard recommendations for incorporating acupuncture into a treatment plan.

"Acupuncture can really make difference, and this has been shown in many studies," explains Lixing Lao, PhD, LAc, professor of family and community medicine at the University of Maryland School of Medicine. "Acupuncture is effective for osteoarthritis and headaches, for nausea and vomiting during chemotherapy and morning sickness, for menstrual disorders and fertility issues. In general, pain studies have found that acupuncture is more effective than conventional medicine, with almost twice as much benefit to the patient."

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Over the past 14 years, researchers at the University of Maryland School of Medicine have conducted sophisticated studies on the effectiveness of acupuncture. One four-year study, published in the Annals of internal Medicine, found that acupuncture benefits people who have knee osteoarthritis and continue to experience significant pain after taking pain medications. Overall, these patients reported a 40% improvement in both pain and functioning.

An analysis of seven previously published studies involving more than 1300 women found positive results for acupuncture used during in vitro fertilization. When acupuncture was performed during embryo transfer, pregnancy rates improved by 65%.

Acupuncture Research Faces Special Challenges

However, acupuncture research faces special challenges. "You can't study acupuncture using the same method you'd use for medications," Lao says, "When a pharmaceutical company researches a new drug, it's easy to create a pill that has the identical color and shape, so neither the researchers nor the patients know who is getting the real medication and who is getting the placebo."

When researchers test acupuncture, what should they compare it with? Several studies at the University of Maryland compared traditional Chinese acupuncture with sham acupuncture, in which practitioners tap acupuncture needles on the skin but do not actually insert them. "In these studies participants really couldn't tell whether they were receiving the real or the sham acupuncture," explains Lao. "We chose specific places for the needles to be inserted based on traditional Chinese medicine. Those who received the sham acupuncture may have felt the edge of the guide tube, but the actual needle did not go in."

The research team found that patients often respond to both traditional Chinese acupuncture and sham acupuncture. One reason is that acupuncture is a visible procedure. "The patient sees the needle and knows they are getting a treatment," Lao notes. "In fact, researchers found a similar effect when they compared a real surgical operation to a sham surgical operation for patients with knee osteoarthritis. People know that something has happened to them, and they respond."

In acupuncture studies, traditional acupuncture consistently produces a stronger effect than sham acupuncture, Lao says, but it's not a statistically significant difference. There's continuing discussion and debate among academics who seek additional research to clarify the reasons for acupuncture's effectiveness.

However, patients generally don't care about the intricacies of academic research, Lao says. "When I ask my patients about their reactions to these studies, they say, 'I don't care. With acupuncture I experience twice the benefit compared to drugs, and I don't have the side effects I'd get from drugs. I'm fine, it worlds--I don't care where you put the needle.' If I tell them that the benefit they experience may be due in part to the placebo effect, they say, 'So what? I feel better.'"

Community-Based MD Relies on Acupuncture

Lisa Albanese, MD, is a community-based physician in practice at Oregon Medical Group (Eugene, Oregon). She trained in physical medicine and rehabilitation, and uses acupuncture as part of her practice.

"Pain management benefits from many different modalities," she says. "Acupuncture has been used for thousands of years, and has been beneficial for many patients. I knew this was an interest I wanted to pursue at some point, and then the opportunity became available."

Albanese took a 300-hour course in medical acupuncture offered by the Helms Medical Institute in Los Angeles. The director of her residency program in rehabilitation medicine had a clinical practice in acupuncture, so she found opportunities for acupuncture practice and mentorship during her residency.

Nowadays, she sees a wide variety of patients who are experiencing pain, and finds that acupuncture works especially well for acute injuries. "It only takes a couple of treatments to tone down many muscular injuries," she says. "I also use acupuncture a great deal with chronic pain issues, as an adjunct to other treatments. I've seen particularly effective results with chronic tension headaches that aren't responding well to other treatments."

Her treatment program for chronic conditions often includes lifestyle changes and physical therapy, as well as acupuncture. "Part of the way acupuncture works is to activate the endogenous opioid system," she observes. "Patients who are taking opioids orally may have a somewhat lower response to acupuncture, because they are not able to activate the body's natural opioid system."

Albanese says that generally people tolerate acupuncture quite well, and often find the treatment relaxing. "I ask my patients to take it easy for the rest of the day after a treatment. They may experience some increase in tiredness, or euphoria, or a 'head in the clouds' sensation. I ask them to refrain from major physical activity and drink lots of fluids."

Patients with chronic pain may experience two to three days of relief after acupuncture, and then return to their baseline level; they may also experience cumulative effects that decrease pain levels over the long run. "We need to look at increasing functionality as well as pain reduction when we consider the effects of treatment," Albanese says. "People may find that they still experience a similar level of pain, but are able to be active for two or three times longer after treatment."

In the US, master's-level practitioners of acupuncture and Oriental medicine follow a three-year program that includes more than 1900 hours of professional curriculum and clinical training. Many MDs practice acupuncture after taking a 300-hour training course. "Extensive training is beneficial when dealing with complicated cases," says Lao. "However, a physician who has trained in a 300-hour course can be extremely effective using acupuncture to treat basic conditions such as headache or back pain, if he or she has sufficient years of practice."

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True expertise in acupuncture develops over time. "Acupuncture is very skill-dependent," Lao says. "Needle manipulation techniques require time to practice." Diagnosis is another important skill that ripens over the years, "Patients may come in complaining of headache and respond readily to treatment," he says. "However, some people have chronic, very complicated conditions. If you want to treat those conditions most effectively, then you don't look for simple symptomatic relief. In these cases you want to address the underlying problems, and this sort of complex diagnosis requires more extensive training."

Resources

The University of Maryland Center for Integrative Medicine

* Acupuncture Questions and Answers:

http://www.umm.edu/features/acupuncture_qa.htm

* Acupuncture research, osteoarthritis of the knee: http://www.umm.edu/news/releases/acupunaure.htm

* Acupuncture research, in-vitro fertilization: http://somvweb.som.umaryland.edu/absolutenm/templates/?a = 42l &z = 13

Helms Medical Institute: http://www.hmieducation.com

Elaine Zablocki has been a freelance health-care journalist for more than 20 years. She was the editor of Alternative Medicine Business News and CHRF News Files. She writes regularly for many health-care publications.
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