The Impact of Acupuncture on Human Health and Well-Being
Over many centuries the miraculous results and captivating ideology surrounding the practice of acupuncture has fascinated the world. Classified as a part of Complementary and Alternative medicine (treatments or practices which are not a part of a country’s mainstream healthcare system), the therapy is generally acknowledged to have originated in China around 3000 years ago and has been used to treat conditions and alleviate pain ever since. In the last century especially as the interest in acupuncture has developed outside of China, so has the level of its integration into other countries’ wider healthcare systems. During this surge of integration, we should be asking- how valid is the use of acupuncture for bettering physical and mental well-being?
What is acupuncture?
Acupuncture was developed alongside Qi; a concept which is seen as one of the ‘roots’ of traditional Chinese medicine. Qi (which is pronounced as chee) can be directly translated to “vital energy” and it is believed to flow around the human body in pathways known as meridians. In accordance with the principles, the misbalance of Yin and Yang (the two opposing aspects of Qi) can lead to the displacement of a person’s Qi, resulting in disease. Acupuncture was a therapy developed to correct the misbalance of Ying and Yang, restoring a person’s Qi and bringing said person back to good health. During an acupuncture therapy session, fine needles are inserted through the skin at specific acupuncture points into either the connective tissue or muscles in the body.
How does acupuncture work?
The majority of the effects of acupuncture treatment are explainable. Pain alleviation has been explained to be caused by the acupuncture needles stimulating A-delta fibers which then enter the grey matter of the dorsal horn and cause an inhibition of slower unmyelinated C fibers (the fibers pain impulses travel via). Another cause of pain relief from the therapy is the activation of encephalin in interneurons, resulting in the inhibition of pain impulses from travelling to the brain. Acupuncture can also result in the brain producing endorphins and endogenous opioids which also result in pain relief for the patient. Whilst all of these points can be used to explain some of the effects of the therapy, there are no clear explanations for some other effects. This includes the effects acupuncture can have on the body’s internal organs and the effects of auricular acupuncture; acupuncture of the external ear which has outcomes relief of symptoms caused by allergies and relief of symptoms caused by endocrine system disorders.
The benefits of acupuncture
Different acupuncture practitioners practicing different forms of acupuncture around the world claim the therapy is able to aid with a wide range of conditions. Although the National Institute for Health and Care Excellence (NICE) recommends the therapy only for chronic tension-type symptoms such as migraines, in the West the therapy is also commonly used for conditions such as: osteoarthritis, epicondylitis, and fibromyalgia as well as commonly experienced symptoms such as nausea/ vomiting. As well as the physical conditions mentioned above, a large number of patients using CAM, including acupuncture, do so as a result of experiencing symptoms linked to mental disorders such as insomnia. In 1998 it was recorded that in the UK and US, 25.3% of patients making use of CAM therapies had at least one anxiety disorder. Acupuncture specifically has been linked to generating a calming effect, leading to patients with anxiety disorders and minor depression experiencing a decrease in their symptoms. Due to the therapy garnering interest in such a wide range of conditions, there has been an increased interest in research into whether or not acupuncture can actually alleviate pain or decrease a patient’s symptoms for the large spectrum of conditions it is used for.
Interestingly, in the West merely a quarter of physicians recommend the therapy and refer patients to acupuncture practitioners due to there still being prevalent skepticism within the medical community. Therefore, patients who make use of acupuncture have the most commonly self-referred (39%). The skepticism within the Western medical community is most likely to be as a result of the difficulty in proving the efficacy of acupuncture therapy. Most of the common uses of acupuncture in the US and UK, mentioned above, have been proven through several hundred random control trials (RCTs) and also controlled clinical trials (CCTs) to have effects which are not caused by a placebo effect. The same however cannot be said for all conditions. According to a national survey conducted in the UK in 2006, the most common reason for patients to seek symptom relief through acupuncture was due to musculoskeletal problems. Whilst some musculoskeletal symptoms can be alleviated through the therapy, for example: back pain, which has had 25 RCTs carried out which point towards acupuncture being effective, some studies surrounding musculoskeletal conditions point towards acupuncture not having efficacy in this area. Osteoarthritis has had 10 RCTS and 2 CCTs conducted in order to determine therapeutic efficacy and the reviews of the results of these studies point towards acupuncture not being effective in alleviating associated pain. Reviews of trials on neck pain (14 RCTs) and shoulder pain (9 RCTs) also show acupuncture as being ineffective in regards to pain relief. However, for certain conditions the results of studies are auspicious; fibromyalgia (3 RCTs and 4 cohort studies), dental pain (16 CCTs) and nausea/ vomiting (26 RCTs) all demonstrate the efficacy of the therapy.
Psychological disorders were the second most likely reason for use of acupuncture in the UK (11%), and clinical trials for the effectivity of the therapy in this area are generally promising. Studies on psychological symptoms such as insomnia have been reviewed and concluded to show that acupuncture can effectively increase sleep quality and latency. In 2003 an interesting RCT comparing the effect of acupuncture and the effect of drugs on decreasing clinical symptoms in patients with anxiety neurosis found that a similar percentage of patients had alleviated symptoms with acupuncture as with the drugs (94.3% acupuncture, 96.4% drugs). Whilst this study does show favorable results, it should be mentioned that although it involved the randomization of patients in the two comparable groups, it did not involve the blinding of patients or the blinding of assessors. Those clinical trials which show that acupuncture does not have efficacy contribute towards the hypothesis that acupuncture therapy has a placebo effect.
Acupuncture and its placebo effect
Placebo acupuncture needles (sham needles) were produced in order to provide clinical trials with a way of testing whether actual acupuncture needles have a significant difference in effect when compared to a needle which does not actually penetrate skin. Using these sham needles, hundreds of RCTs were carried out, many of which concluded that for most conditions there is no significant difference. However, when interpreting the results of these RCTs, we should also consider the limitations of the sham needles and whether RCTs are the most suitable type of clinical trial to test the efficacy of acupuncture on alleviating symptoms including pain. Whilst the majority of the clinical trials carried out suggest that there is an insignificant difference between the use of real acupuncture needles and sham needles, the use of either when compared to no therapy at all has very promising results. A reason as to why the placebo effect sham needles show seems to be so effective is because it is not a true placebo. Unlike placebo pills, sham needles are a physical placebo and are therefore not fully ‘inert’ as they still involve stimulation with touch and pressure which could still cause some physiological effects within the body.
In addition to sham needles not being a fully ‘inert’ placebo, RCTs might not be the best way of investigating whether acupuncture has efficacy. RCTs are usually used in order to evaluate whether or not pharmacological treatments work, therefore they are not fully appropriate to use when evaluating if physical therapies like acupuncture are effective. As a result of the questionable nature of using RCTs and sham needles to investigate the efficacy of acupuncture, the difference between acupuncture and placebo needles should be less of a focus and the attention of clinical trials should be shifted towards why acupuncture has such a powerful placebo response.
The risks involved with acupuncture
With acupuncture being a CAM therapy without an official governing body, the risks and safety of the practice can be difficult to evaluate. Adverse effects can range from minor events such as: dizziness, nausea, and bruising to major ones such as patients contracting the hepatitis B infection (due to the therapy being carried out by unregistered practitioners). In a study of 55,000 cases of treatment, only 63 negative effects were caused by the therapy. This included the most common cases of 16 forgotten needles (which were retrieved following appointments), and 13 cases of transient hypotension. On the whole, acupuncture is generally regarded to be a safe practice, especially if it is being carried out by an experienced, registered practitioner.
We still have much to learn about ever enigmatic practice of acupuncture, such as why it has such a mystically great placebo effect on patients. Whilst this is used by many Western physicians as an argument to not adopt the therapy further into healthcare systems, surely the major proved benefits (for certain conditions) and the large impact the therapy has on patients should suggest otherwise. Ranging from the alleviation of pain for musculoskeletal conditions to reducing stress and clinical symptoms of psychological conditions, acupuncture can and should be used as a greatly beneficial therapy in aiding human health and well-being.
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