Acupuncture is a traditional form of Chinese medical treatment that has been practiced for over 2000 years. It involves piercing the skin with needles at specific body sites. The placement of needles into the skin is dictated by the location of meridians. These meridians, or channels, are thought to mark patterns of energy, called Qi (Chi), that flow through the human body. According to traditional Chinese philosophy, illness occurs when the energy flow is blocked or unbalanced, and acupuncture is a way to influence chi and restore balance. Another tenet of this philosophy is that all disorders are associated with specific points on the body, on or below the skin surface.
Several physiologic explanations of acupuncture's mechanism of action have been proposed, including an analgesic effect from the release of endorphins or hormones (e.g., cortisol, Oxytocin), a bio-mechanical effect, and/or an electromagnetic effect.
There are 361 classical acupuncture points located along 14 meridians, and different points are stimulated depending on the condition treated. In addition to traditional Chinese acupuncture, there are a number of modern styles of acupuncture, including Korean and Japanese acupuncture. Modern acupuncture techniques can involve stimulation of additional non-meridian acupuncture points. Acupuncture is sometimes used along with manual pressure, heat (moxibustion), or electrical stimulation (electroacupuncture). Acupuncture treatment can vary by style and by practitioner and is personalized to the patient. Thus, patients with the same condition may receive stimulation of different acupuncture points.
The scientific study of acupuncture is challenging due to the multi-factorial nature of the intervention, variability in practice, and individualization of treatment. There has been much discussion in the literature on the ideal control condition for studying acupuncture. Ideally, the control condition should be able to help distinguish between specific effects of the treatment and nonspecific placebo effects related to factors such as patient expectations and beliefs and the patient-provider therapeutic relationships. A complicating factor in the selection of a control treatment is that it is not clear whether all 4 components (ie, the acupuncture needles, the target location defined by traditional Chinese medicine, the depth of insertion, and the stimulation of the inserted needle) are necessary for efficacy. Sham acupuncture interventions vary; they can involve, e.g., superficial insertion of needles or insertion of needles at the "wrong" points. A consensus recommendation on clinical trials of acupuncture, published by White et al (2002), recommend distinguishing between a penetrating and a nonpenetrating sham control.
Acupuncture has been used to treat a large variety of conditions. This review addresses acupuncture for treating chronic pain, to ameliorate nausea and vomiting symptoms, and to alleviate withdrawal symptoms of opioid users.
The U.S. Food and Drug Administration has cleared acupuncture needles for marketing but does not regulate the practice of acupuncture.
Acupuncture may be considered medically necessary for treatment of episodic migrainesand/ortension-type headaches.
Acupuncture is considered investigational for the treatment of other pain-related conditions including but not limited to:
Acupuncture is considered investigational for the prevention or treatment of nausea and/or vomiting.
Acupuncture is considered investigational for opioid reduction or cessation in opiate users.
Practice Guidelines and Position Statements
American College of Rheumatology
The 2012 guidelines from the American College of Rheumatology on the treatment of osteoarthritis (OA) with acupuncture recommended the following:
"Treatment with traditional Chinese acupuncture or instruction in the use of transcutaneous electrical stimulation are conditionally recommended only when the patient with knee OA has chronic moderate to severe pain and is a candidate for total knee arthroplasty but either is unwilling to undergo the procedure, has comorbid medical conditions, or is taking concomitant medications that lead to a relative or absolute contraindication to surgery or a decision by the surgeon not to recommend the procedure…."
National Institute for Health and Care Excellence
In 2012, the National Institute for Health and Care Excellence guidance on the diagnosis and management headaches in those over 12 years of age recommended a course of up to 10 sessions of acupuncture over 5 to 8 weeks for prophylactic treatment of chronic tension-type headaches.
For migraines, the guidance recommended a course of up to 10 sessions of acupuncture over 5 to 8 weeks for prophylactic treatment if both Topiramate and Propranolol were unsuitable or ineffective.
The 2016 Institute guidance on the assessment and management of low back pain and sciatica in those over 16 years of age recommended not offering acupuncture for low back pain with or without sciatica.