Advice by Trisha Pasricha, MD, MPH July 24, 2023 at 11:00 a.m. EDT
(Chelsea Conrad/The Washington Post; iStock)
Q: I’ve tried a lot of medicines for my chronic pain and nothing works. Should I try acupuncture?
A: Critics once dismissed the benefits of acupuncture as purely a placebo effect, a notion that still lingers among a portion of the public. But research has found a benefit for certain conditions, including chronic pain.
The data is so promising that, in 2020, the Centers for Medicare and Medicaid Services started covering acupuncture therapy for chronic low back pain. Clinical trials over the past several decades have suggested acupuncture may be a beneficial treatment for other conditions, such as chronic obstructive pulmonary disease and constipation.
To determine if acupuncture really works, researchers have compared it to “sham” acupuncture.
Acupuncture is a treatment composed of activating specific locations — or acupoints — on the body, commonly with fine needles. In traditional East Asian medicine, activating acupoints is thought to help restore the flow of chi, the body’s vital energy.
In sham acupuncture, the acupuncturist inserts needles, but deliberately avoids established acupoints. It’s not a perfect double-blind system, because trained acupuncturists know they’re administering a sham.
From the patient’s perspective, however, the experience is essentially the same. And if the benefits of acupuncture were entirely due to a placebo effect, the sham and the real thing would produce similar results.
In some cases, they don’t.
A 2018 meta-analysis of over 20,000 patients in 39 high-quality randomized controlled trials found that acupuncture was superior to both sham and no acupuncture for back or neck pain, osteoarthritis, headaches and shoulder pain. These outcomes mostly persisted over time — even after 12 months of receiving treatment.
But it isn’t a magic cure-all. Like any treatment, it may not be a good fit for everyone. Though it’s popular among people undergoing in vitro fertilization treatments, for example, research has shown it does not improve fertility.
The science of acupuncture
Some skepticism persists over a lack of explanation from a Western medicine perspective of how acupuncture works. But scientists have started to unlock the answer: The brain.
“People talk about psychedelics reshaping the nervous system. Acupuncture kind of does the same thing,” said Richard Harris, a professor and endowed chair of the University of California, Irvine Susan Samueli Integrative Health Institute.
His group conducted a series of analyses on acupuncture among chronic pain patients. They found that acupuncture — but not sham — changed brain activity in terms of activating the receptors that bind opioids, which help control pain in the body. Electroacupuncture, in which the needles are stimulated with minor electrical currents, also impacted how different areas of the brain were connected, essentially rewiring the brain’s pain network.
Consider this: In a 2017 study of 80 patients with carpal tunnel syndrome, scientists discovered that electroacupuncture of the afflicted wrist was as effective in relieving symptoms as acupuncture at the opposite ankle.
How could that be?
Subjective recovery aside, both groups had improvement in how well the median nerve of the wrist could transmit electrical signals — which didn’t happen to those who got sham acupuncture. This would suggest that acupuncture can act locally where the needle is placed, but also may have the ability to act on parts of the body nowhere near that spot.
One way this could occur is via the central nervous system. So scientists looked at the subjects’ brains using functional MRI imaging. They found that needling at the wrist and ankle both resulted in significant changes to how stimulation to the fingers was mapped onto the cerebral cortex.
More research is needed to further uncover the ways acupuncture influences the body, but studies have provided convincing evidence that it’s far more than just a placebo effect.
What are acupoints?
The World Health Organization consensus recognizes 361 standardized acupoints on the human body. Acupoints appear to respond to varied stimulation, such as from pressure, heat and electricity.
There’s still a lot we don’t know about how acupoints work. Some studies have shown that traditional acupoints may have a high density of nerve endings and mast cells. Stimulating these areas may lead to the release of chemicals in the body (such as hormones) and ultimately impact the brain.
Piecing together what defines an acupoint, how they relate to each other and their physiological importance is a critical area of research funded by the National Institutes of Health.
Is acupuncture safe?
If you’re considering acupuncture, talk to your physician about your options, and ask them about finding a qualified acupuncturist in your area.
Acupuncture is generally considered safe when done by a well-trained practitioner. Serious complications and fatalities related to it are exceedingly rare. Fainting or pain at the site of needle insertion are also infrequent.
The risks are not zero, but they can be lower than those associated with some pain medications.
What I want my patients to know
Some people in the United States are biased against treatments not based in Western medicine. But when doctors like me suggest acupuncture to their patients — which I often do for pain or constipation — it’s not because we’ve run out of ideas, or that we’re grasping for a last resort. We recommend it precisely because of how compelling the data is.
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