Modern Science Battles Ancient Tradition Over Acupuncture
So you have back pain, and you’re suffering. How many activities, actions, and tasks don’t involve the back? Ask anyone with a chronic and painful condition that is causing back pain, and you will get an immediate response: NONE! How to find relief? What to do if the usual first-line treatments for this problem have been attempted, with inadequate benefits obtained? Injection therapy, a brace, physical therapy, these and many others may be utilized in the treatment of chronic back pain, but it is not infrequent that these fail.
There are many applications for the ancient Chinese practice of acupuncture, and back pain is a certainly a very common one. Many studies have indeed shown that it can be of benefit in reducing pain. The next question to many Western physicians and scientists is how? The practice of acupuncture involves the insertion of very fine needles into various parts of the body. It is really an assortment of procedures, all which involve the stimulation of various locations on or in the skin by a variety of techniques. There are a number of different approaches to diagnosis and treatment in American acupuncture. The most thoroughly studied mechanism of stimulation of acupuncture points employs penetration of the skin by thin, solid, metallic needles, which are manipulated manually or by electrical stimulation.
Contrary to popular belief, acupuncture is not just a system for inserting these needles into specific body locations to alleviate pain. It is actually a medical philosophy, or concept, that many painful conditions and medical problems are due to an imbalance of energy in the body. And that is where a great divide occurs between these two disparate philosophies. Western science has never been able to prove or validate this theory that these energy channels exist. Ancient Eastern medicine is, to some degree, based on their existence.
One of the problems for scientists is the nature of the studies that have been performed to demonstrate the benefits of this system of medicine. Typically, by and large, these studies have been poorly constructed, with inaccurate or undependable results, and are therefore open to criticism. Medical studies are difficult to create that provide concrete proof of any theory or concept. Just as statistics can lie, so to can the studies that created those stats. Many different types of studies exist that produce varying “levels of evidence”. To date, those studies published to prove the therapeutic effects of acupuncture have been generally poor.
Regardless, acupuncture is becoming increasingly recognized by Western medicine as an effective adjunct to conventional treatments. It is currently prescribed for a great variety of conditions, including migraine headaches, arthritic joint conditions, asthma, and even the aforementioned low back pain. Acupuncture has been utilized with some success for the nausea of chemotherapy and pregnancy. Because acupuncture has so many positive effects on the body with minimal incidence of side effects, it is often considered when developing a treatment plan.
But there are side effects and complications possible with acupuncture. Acupuncture is generally considered safe when performed by an experienced, well-trained practitioner using sterile needles. Improperly performed acupuncture can cause serious side effects. The most commonly reported acupuncture-related adverse events include a superficial collecting of blood at the site of needling, sleeplessness, and sharp pain. However, these occur infrequently, and are mild or transient. Although uncommon in the US, acupuncture needles might not be sterilized, which obviously can result in bacterial and viral infections.
In some rare instances, acupuncture has actually been dangerous. The needles have sometimes been inserted not only into the skin, but deep into the body; serious harm may result if vital structures are penetrated. In one very unusual case of back pain, needles were inserted through the skin of the chest, leading to a collapsed lung, which filled the chest cavity with blood. Death from puncture of the heart has been reported. Other reports mention puncture of the liver, spleen, bladder, and kidneys.
The medicinal effects of acupuncture are all based on its alteration of ‘chi’ energy. Because of our inability to demonstrate this energy, it’s existence is questioned, and the benefits of acupuncture discounted. Many would posit that simply because we can’t yet demonstrate this energy, does that mean it does not exist? Perhaps acupuncture produces some changes in the body that can be measured by Western science. Research has begun to elucidate some possible mechanisms of action. One such study demonstrated the release of opioids and other peptides in the central and peripheral nervous systems, as well as other changes in the functioning of the nervous and endocrine (hormonal) systems.
Research published recently in a scientific journal demonstrated that the effects of acupuncture needling include influencing the activity of adenosine, an amino acid which becomes active in the skin after an injury, to ease pain. This may explain in part why pain relief is often experienced as one of the benefits of acupuncture. Although much needs to be accomplished, the emergence of plausible mechanisms for the therapeutic effects of acupuncture is encouraging.
Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient appears to be unimportant in eliciting therapeutic benefits. These findings raise questions about acupuncture’s purported mechanisms of action. It remains unclear whether acupuncture, or a simulated method of acupuncture, provide physiologically important stimulation, or represent a placebo effect. Another problem for proponents of acupuncture is that some carefully controlled scientific studies show that it does not matter where you stick the needles, or even if you insert needles. Some benefits are possible simply by poking the skin with dull needles, or retracting needles. Still, studies comparing true and faked acupuncture do reveal statistically significant differences. This would indicate that it provides for more than a placebo effect, even though sometimes these differences are small.
Chronic pain in the muscles and joints can make life miserable. Standard treatments like ice and heat, anti-inflammatory medications, physical therapy, and appropriate exercises can often ease the pain. But when they don’t, acupuncture is an option with a good track record that’s worth considering. There are benefits to being open-minded about options for treatment. Whether improvements gained with acupuncture are due to the treatment, or the amazing healing power of the mind, is a question we just don’t yet have an answer to. Stay tuned for the next installment in the on-going debate on the benefits of acupuncture.