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Any decision
you make about your health care is important--including deciding
whether to use acupuncture. The National Center for Complementary
and Alternative Medicine (NCCAM) has developed this fact sheet to
provide you with information on acupuncture. It includes frequently
asked questions, issues to consider, and a list of sources for
further information. Terms that are underlined are defined at the
end of this fact sheet.
Key Points
- Acupuncture originated in China more than 2,000 years ago,
making it one of the oldest and most commonly used medical
procedures in the world.
- It is important to inform all of your health care providers
about any treatment that you are using or considering, including
acupuncture. Ask about the treatment procedures that will be used
and their likelihood of success for your condition or disease.
- Be an informed consumer and find out what scientific studies
have been done on the effectiveness of acupuncture for your health
condition.
- If you decide to use acupuncture, choose the practitioner with
care. Also check with your insurer to see if the services will be
covered.
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What is acupuncture?
Acupuncture is one of the oldest, most commonly used medical
procedures in the world. Originating in China more than 2,000 years
ago, acupuncture began to become better known in the United States
in 1971, when New York Times reporter James Reston wrote about how
doctors in China used needles to ease his pain after surgery.
The term acupuncture describes a family of procedures involving
stimulation of anatomical points on the body by a variety of
techniques. American practices of acupuncture incorporate medical
traditions from China, Japan, Korea, and other countries. The
acupuncture technique that has been most studied scientifically
involves penetrating the skin with thin, solid, metallic needles
that are manipulated by the hands or by electrical stimulation.
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How widely is acupuncture used in the United States
In the past two decades, acupuncture has grown in popularity in
the United States. The report from a Consensus Development
Conference on Acupuncture held at the National Institutes of Health
(NIH) in 1997 stated that acupuncture is being "widely"
practiced--by thousands of physicians, dentists, acupuncturists, and
other practitioners--for relief or prevention of pain and for
various other health conditions.1
According to the 2002 National Health Interview Survey--the largest
and most comprehensive survey of complementary
and alternative medicine (CAM) use by American adults to
date--an estimated 8.2 million U.S. adults had ever used
acupuncture, and an estimated 2.1 million U.S. adults had used
acupuncture in the previous year.2
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What does acupuncture feel like?
Acupuncture needles are metallic, solid, and hair-thin. People
experience acupuncture differently, but most feel no or minimal pain
as the needles are inserted. Some people are energized by treatment,
while others feel relaxed.3
Improper needle placement, movement of the patient, or a defect in
the needle can cause soreness and pain during treatment.4
This is why it is important to seek treatment from a qualified
acupuncture practitioner.
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Is acupuncture safe?
The U.S. Food and Drug Administration (FDA) approved acupuncture
needles for use by licensed practitioners in 1996. The FDA requires
that sterile, nontoxic needles be used and that they be labeled for
single use by qualified practitioners only.5
Relatively few complications from the use of acupuncture have
been reported to the FDA in light of the millions of people treated
each year and the number of acupuncture needles used. Still,
complications have resulted from inadequate sterilization of needles
and from improper delivery of treatments. Practitioners should use a
new set of disposable needles taken from a sealed package for each
patient and should swab treatment sites with alcohol or another
disinfectant before inserting needles. When not delivered properly,
acupuncture can cause serious adverse effects, including infections
and punctured organs.6
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Does acupuncture work?
According to the NIH Consensus Statement on Acupuncture, there
have been many studies on acupuncture's potential usefulness, but
results have been mixed because of complexities with study design
and size, as well as difficulties with choosing and using placebos or
sham acupuncture. However, promising results have emerged, showing
efficacy of acupuncture, for example, in adult postoperative and
chemotherapy nausea and vomiting and in postoperative dental pain.
There are other situations--such as addiction, stroke
rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia,
myofascial pain, osteoarthritis, low-back pain, carpal tunnel
syndrome, and asthma--in which acupuncture may be useful as an
adjunct treatment or an acceptable alternative or be included in a
comprehensive management program. An NCCAM-funded study recently
showed that acupuncture provides pain relief, improves function for
people with osteoarthritis of the knee, and serves as an effective
complement to standard care.7
Further research is likely to uncover additional areas where
acupuncture interventions will be useful.8
NIH has funded a variety of research projects on acupuncture.
These grants have been funded by NCCAM, its predecessor the Office
of Alternative Medicine, and other NIH institutes and centers.
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How might acupuncture work?
Acupuncture is one of the key components of the system of traditional
Chinese medicine (TCM). In the TCM system of medicine, the body
is seen as a delicate balance of two opposing and inseparable
forces: yin and yang. Yin represents the cold, slow, or passive
principle, while yang represents the hot, excited, or active
principle. Among the major assumptions in TCM are that health is
achieved by maintaining the body in a "balanced state" and that
disease is due to an internal imbalance of yin and yang. This
imbalance leads to blockage in the flow of qi (vital
energy) along pathways known as meridians.
It is believed that there are 12 main meridians and 8 secondary
meridians and that there are more than 2,000 acupuncture points on
the human body that connect with them.
Preclinical
studies have documented acupuncture's effects, but they have not
been able to fully explain how acupuncture works within the
framework of the Western system of medicine that is commonly
practiced in the United States.9-14
It is proposed that acupuncture produces its effects through
regulating the nervous system, thus aiding the activity of
pain-killing biochemicals such as endorphins and immune system cells
at specific sites in the body. In addition, studies have shown that
acupuncture may alter brain chemistry by changing the release of
neurotransmitters and neurohormones and, thus, affecting the parts
of the central nervous system related to sensation and involuntary
body functions, such as immune reactions and processes that regulate
a person's blood pressure, blood flow, and body temperature.15,16
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How do I find a licensed acupuncture practitioner?
Health care practitioners can be a resource for referral to
acupuncturists. More medical doctors, including neurologists,
anesthesiologists, and specialists in physical medicine, are
becoming trained in acupuncture, TCM, and other CAM therapies. In
addition, national acupuncture organizations (which can be found
through libraries or Web search engines) may provide referrals to
acupuncturists.
- Check a practitioner's credentials.
An
acupuncture practitioner who is licensed and credentialed may
provide better care than one who is not. About 40 states have
established training standards for acupuncture certification, but
states have varied requirements for obtaining a license to
practice acupuncture.17
Although proper credentials do not ensure competency, they do
indicate that the practitioner has met certain standards to treat
patients through the use of acupuncture.
- Do not rely on a diagnosis of disease by an acupuncture
practitioner who does not have substantial conventional medical
training.
If you have received a diagnosis from a
doctor, you may wish to ask your doctor whether acupuncture might
help.
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How much will acupuncture cost?
A practitioner should inform you about the estimated number of
treatments needed and how much each will cost. If this information
is not provided, ask for it. Treatment may take place over a few
days or for several weeks or more. Physician acupuncturists may
charge more than nonphysician practitioners.
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Will it be covered by my insurance?
Acupuncture is one of the CAM therapies that are more commonly
covered by insurance. However, you should check with your insurer
before you start treatment to see whether acupuncture will be
covered for your condition and, if so, to what extent. Some
insurance plans require preauthorization for acupuncture. (For more
information, see NCCAM's fact sheet "Consumer Financial
Issues in Complementary and Alternative Medicine")
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What should I expect during my first visit?
During your first office visit, the practitioner may ask you at
length about your health condition, lifestyle, and behavior. The
practitioner will want to obtain a complete picture of your
treatment needs and behaviors that may contribute to your condition.
Inform the acupuncturist about all treatments or medications you are
taking and all medical conditions you have.
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Definitions
Complementary and alternative medicine
(CAM): A group of diverse medical and health care systems,
practices, and products that are not presently considered an
integral part of conventional
medicine. Complementary medicine is used together with
conventional medicine, and alternative medicine is used in
place of conventional medicine. Some health care providers practice
both CAM and conventional medicine.
Conventional medicine: A whole medical
system practiced by holders of M.D. (medical doctor) or D.O. (doctor
of osteopathy) degrees and by their allied health professionals,
such as physical therapists, psychologists, and registered nurses.
Other terms for conventional medicine include allopathy; Western,
mainstream, and orthodox medicine; and biomedicine.
Fibromyalgia: A complex chronic
condition having multiple symptoms, including muscle pain, fatigue,
and tenderness in precise, localized areas, particularly in the
neck, spine, shoulders, and hips. People with this syndrome may also
experience sleep disturbances, morning stiffness, irritable bowel
syndrome, anxiety, and other symptoms.
Meridian: A traditional Chinese
medicine term for each of the 20 pathways throughout the body for
the flow of qi, or vital energy, accessed through acupuncture
points.
Placebo: An inactive pill or sham
procedure given to a participant in a research study as part of a
test of the effects of another substance or treatment. Scientists
use placebos to get a true picture of how the substance or treatment
under investigation affects participants. In recent years, the
definition of placebo has been expanded to include such things as
aspects of interactions between patients and their health care
providers that may affect their expectations and the study's
outcomes.
Preclinical study: A study done to
obtain information about a treatment's safety and side effects when
given at different doses to animals or to cells grown in the
laboratory.
Qi: A Chinese term for vital energy or
life force. In traditional Chinese medicine, qi (pronounced "chee")
is believed to regulate a person's spiritual, emotional, mental, and
physical balance, and to be influenced by the opposing forces of yin
and yang.
Traditional Chinese medicine (TCM): A
whole medical system that was documented in China by the 3rd century
B.C. TCM is based on a concept of vital energy, or qi, that is
believed to flow throughout the body. It is proposed to regulate a
person's spiritual, emotional, mental, and physical balance and to
be influenced by the opposing forces of yin (negative energy) and
yang (positive energy). Disease is proposed to result from the flow
of qi being disrupted and yin and yang becoming unbalanced. Among
the components of TCM are herbal and nutritional therapy,
restorative physical exercises, meditation, acupuncture, and
remedial massage.
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References
- Culliton PD. Current utilization of acupuncture by United
States patients. Abstract presented at: National Institutes of
Health Consensus Development Conference on Acupuncture; 1997.
- Barnes PM, Powell-Griner E, McFann K, Nahin RL.
Complementary and alternative medicine use among adults: United
States, 2002. CDC Advance Data Report #343. 2004.
- American Academy of Medical Acupuncture.
Doctor, What's This Acupuncture All About? A Brief
Explanation. American Academy of Medical Acupuncture Web site.
Accessed at www.medicalacupuncture.org/acu_info/articles/aboutacupuncture.html
on December 14, 2004.
- Lao L. Safety issues in acupuncture. Journal
of Alternative and Complementary Medicine. 1996;2(1):27-31.
- U.S. Food and Drug Administration. Acupuncture
needles no longer investigational. FDA Consumer.
1996;30(5). Also available at: www.fda.gov/fdac/departs/596_upd.html.
- Lytle CD. An Overview of Acupuncture.
Rockville, MD: U.S. Food and Drug Administration, Center for
Devices and Radiological Health; 1993.
- Berman BM, Lao L, Langenberg P, et al.
Effectiveness of acupuncture as adjunctive therapy in
osteoarthritis of the knee: a randomized, controlled trial.
Annals of Internal Medicine. 2004;141(12):901-910.
- National Institutes of Health Consensus Panel.
Acupuncture: National Institutes of Health Consensus
Development Statement. National Institutes of Health Web site.
Accessed at odp.od.nih.gov/consensus/cons/107/107_statement.htm
on December 14, 2004.
- Eskinazi DP. NIH Technology Assessment Workshop
on Alternative Medicine: Acupuncture. Gaithersburg, Maryland, USA,
April 21-22, 1994. Journal of Alternative and Complementary
Medicine. 1996;2(1):1-256.
- Tang NM, Dong HW, Wang XM, et al.
Cholecystokinin antisense RNA increases the analgesic effect
induced by electroacupuncture or low dose morphine: conversion of
low responder rats into high responders. Pain.
1997;71(1):71-80.
- Cheng XD, Wu GC, He QZ, et al. Effect of
electroacupuncture on the activities of tyrosine protein kinase in
subcellular fractions of activated T lymphocytes from the
traumatized rats. Acupuncture and Electro-Therapeutics
Research. 1998;23(3-4):161-170.
- Chen LB, Li SX. The effects of electrical
acupuncture of Neiguan on the PO2 of the border zone between
ischemic and non-ischemic myocardium in dogs. Journal of
Traditional Chinese Medicine. 1983;3(2):83-88.
- Lee HS, Kim JY. Effects of acupuncture on blood
pressure and plasma renin activity in two-kidney one clip
Goldblatt hypertensive rats. American Journal of Chinese
Medicine. 1994;22(3-4):215-219.
- Okada K, Oshima M, Kawakita K. Examination of
the afferent fiber responsible for the suppression of jaw-opening
reflex in heat, cold, and manual acupuncture stimulation in rats.
Brain Research. 1996;740(1-2):201-207.
- Takeshige C. Mechanism of acupuncture analgesia
based on animal experiments. In: Pomerantz B, Stux G, eds.
Scientific Bases of Acupuncture. Berlin, Germany:
Springer-Verlag; 1989.
- Lee BY, LaRiccia PJ, Newberg AB. Acupuncture in
theory and practice. Hospital Physician. 2004;40:11-18.
- White House Commission on Complementary and
Alternative Medicine Policy: Final Report. March 2002. White
House Commission on Complementary and Alternative Medicine Policy
Web site. Accessed at www.whccamp.hhs.gov/finalreport.html
on December 14, 2004.
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For More Information
NCCAM Clearinghouse
The NCCAM Clearinghouse provides information on CAM and on NCCAM,
including publications and searches of Federal databases of
scientific and medical literature. The Clearinghouse does not
provide medical advice, treatment recommendations, or referrals to
practitioners.
Toll-free in the U.S.: 1-888-644-6226
TTY (for deaf and
hard-of-hearing callers): 1-866-464-3615
Web site: nccam.nih.gov
E-mail: info@nccam.nih.gov
CAM on PubMed®
CAM on PubMed, a database on the Web developed jointly by NCCAM
and the National Library of Medicine, offers abstracts of articles
in scientifically based, peer-reviewed journals on complementary and
alternative medicine. Some abstracts link to the full text of
articles.
Web site: www.nlm.nih.gov/nccam/camonpubmed.html
ClinicalTrials.gov
ClinicalTrials.gov is a database of information on clinical
trials, primarily in the United States and Canada, for a wide range
of diseases and conditions. It is sponsored by the National
Institutes of Health and the U.S. Food and Drug Administration.
Web site: http://www.clinicaltrials.gov/
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This publication is not copyrighted and is in the
public domain. Duplication is encouraged.
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NCCAM has provided this material for your
information. It is not intended to substitute for the medical
expertise and advice of your primary health care provider. We
encourage you to discuss any decisions about treatment or care
with your health care provider. The mention of any product,
service, or therapy in this information is not an endorsement
by NCCAM. |
NCCAM Publication No. D003
Date
Revised: December 2004
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