09 Jun Does Acupuncture Work? A Review of Western Theory
When people hear that I am an acupuncturist they usually respond with interest and the question “Does acupuncture really work?” which is promptly followed by another question “Does acupuncture hurt?”.
I typically respond to the first question – ”I hope it works. If it doesnʼt then the rigorous four year program I attended was a big waste of time and money.” I smile and then follow up the question with “Yes (pause) … and no. Acupuncture does work – but it works differently than western medicine.”
This article will explore the Western theories of how acupuncture works. Unfortunately, acupunctureʼs effectiveness cannot be easily explained or easily proven by Western scientific trials.
Although studies on acupuncture effectiveness are increasing in number there are problems in acupuncture research. For example, Western medicine holds great value in randomized controlled trials (RCTʼs). The essence of Chinese Medicine is the individuation of patient diagnosis and treatment. An acupuncturist may see four patients with headache symptoms. It would not be unusual to utilize four different acupuncture treatments each directed to the specific, yet individual site of the headache. In randomized controlled trials each headache participant would receive the same acupuncture treatment. It is impossible to incorporate the essence, or individuation of acupuncture into controlled studies.
There are multiple Western theories of how acupuncture works including the release of neurochemicals, the autonomic release, and the placebo effect. Letʼs begin by looking at the neurochemical release theory.
Numerous studies support the theory that acupuncture works because of neurochemical releases. In the 1980ʼs it was discovered that acupuncture releases opioid peptides, serotonin, norephinephrine and beta-endorphins (Clement-Jones et al 1979, 1980). Beta-endorphins resemble opiates in their ability to produce a feeling of well-being and analgesia. They are considered natural pain relievers.
In laboratory animal studies Bing et al (1991) concludes that insertion of an acupuncture needle in the lateral side of the calf increased the release of opioids in the cerebral spinal fluid (CSF) in the cervical area. It seems that stimulating one area of the body with an acupuncture needle will increase opioid release in the CSF in distal body segments. Acupuncturists see this
Does Acupuncture Work? A Review of Western Theory
daily in the treatment room where shoulder pain is reduced or alleviated by inserting an acupuncture needle in the hip, or neck tension is released by needling specific points on the feet.
The autonomic release theory suggests that acupuncture activates the pain modulatory system and affects the autonomic nervous system (ANS) both peripherally (locally) and internally (centrally). For example, insertion of a needle into a painful contracted muscle stimulates calcitonin gene reactive protein (a neuropeptide that is a powerful vasodilator and functions in pain transmission), cholinergic nerves and sympathetic fibers of the paravertebral ganglia. Subsequent needle stimulation improves tissue function through vasodilation of the skin which causes an immediate flare reaction. The local release of beta-endorphins contributes to the short term analgesic effect. Beta endorphins also decrease pain by inhibiting substance P, another neuropeptide that is an important mediator of pain signals.
The ANS is activated internally or centrally after the ʻpainʼ information is transmitted from the periphery via A Delta fibers to the brain. In the dorsal horn of the spinal cord, opioid peptides are released which “close the gate” to pain, or they inhibit the transmission of the pain information impulses in C fibers. As the fibers travel through the brainstem the beta endorphin is released. This sets off a downward influence on all levels of the spinal cord, called descending inhibitory control, a process that involves serotonin as a transmitter. The inhibitory effect operates by releasing opioid peptides at the dorsal horn, producing widespread analgesia throughout the body (Medical Acupuncture A Western Scientific Approach, Adrian White, MD, pp. 155-156.)
Many skeptics say that acupuncture works because of the placebo effect. In reality 33% to 75% of patients respond to placebo (Benson & McCallie 1979, Richardson 1990, Wall 1994). Dr. Herbert Benson, author of The Mind/Body Effect writes that three components create the placebo effect: (1) positive beliefs and expectations on the part of the patient; (2) positive beliefs and expectations on the part of the physician or health care professional; and (3) a good relationship between the two parties.
The power of the mind (as it relates to healing) is not easily explained or easily proven. The majority of the medical community is familiar with the “Mr. Wright” story as reported in the research literature by Dr. Bruno Klopher. Mr. Wright, a patient in the final stages of cancer was given an experimental drug which he believed would cure him. Immediately he went into remission and
Does Acupuncture Work? A Review of Western Theory
remained so until he began reading that the clinics testing the drug were reporting less than stellar results. Mr Wright began to lose hope and relapsed. Knowing his patientʼs innate optimism, the physician deliberately administered an injection of distilled water (i.e. a placebo) while his patient thought he was receiving a newer version of the trial drug. Mr. Wrightʼs second recovery from near death was even more dramatic until two months later when the final AMA report was published stating the drug was worthless. Within a few days Mr Wright was back in the hospital and died two days later. Dr. H. Benson states, “Belief is one of the most powerful healing tools we have in our therapeutic arsenal.”
Even the most cynical skeptics agree that acupuncture has powerful non- specific (i.e. placebo) effects. They attribute this to the longer consultations that acupuncturists tend to have with their patients (which could be considered therapeutic), or the aura of mystique around acupuncture may also be considered a placebo.
As an acupuncturist I face the challenge of convincing cynics that inserting needles into specific points on the body can help a medical condition. Although the research shows that acupuncture can work it is important to restate that acupuncture works differently than western medicine. The widespread application of acupuncture is recognized by the World Heath Organization (WHO) and the National Institute of Health (NIH). A detailed list of treatable conditions can be found at www.caryacupunctureclinic.com.
Clement-Jones V, McLoughlin, Tomlin S, Besser G M, Rees L H, Wen H L 1980 Increased beta-endorphin but not metankephalin levels in human cerebrospinal fluid after acupuncture for recurrent pain. The Lancet 2:946-949
Bing Z, Villanueva L, Le Bars D 1991 Acupuncture-evoked responses of subnucleus reticularis dorsalis neurons in the rat medulla. Neuroscience 44:693-703
Benson H, McCallie D P 1979 Angina pectoris and the placebo effect. New England Journal of Medicine 300(25):1424-1429
Benson H The Mind/Body Effect 2000, Simon & Schuster, NY
Bruno Kiopfer, 1957 Psychological Variables in Human Cancer. Journal of Projective Techniques 21. pp. 329-40
White Adrian 2006 Medical Acupuncture A Western Scientific Approach, Churchhill Livingston.