WWhen the U.S. opioid crisis exploded a decade ago Dr. Medhat Mikhael was busy talking with his patients about alternative ways of treating pain, including other medications and other treatments.
As a pain management specialist at MemorialCare Orange Coast Medical Center in Fountain Valley, Calif., he didn’t anticipate leaving behind the short-term use of opioids altogether, since they work so well for post-surgical pain. However, he was determined to find a more safe and effective way of treating the pain.
It turned out that this was acupuncture.
“Like any treatment, acupuncture doesn’t work for everyone, but the majority of my patients who have tried it have found relief,” he says. “When I started looking into studies, I discovered how much evidence there was behind this treatment, and that made me feel comfortable suggesting it as an alternative or a complement to pain medication and other treatments.”
This combination of research-backed and anecdotal success is driving acupuncture’s popularity as a treatment. According to a 2021 World Health Organization report, acupuncture is the most widely used traditional medicine practice globally, and it’s gaining traction in the U.S. In 2020, the Centers for Medicare & Medicaid services began covering acupuncture for the first time for chronic low back pain.
Although scientists don’t yet understand all the nuances of how it works, research indicates it can have a significant effect on certain conditions, and it shows promise for others.
What exactly is Acupuncture?
According to Kevin Menard (a Traditional Chinese Medicine Practitioner in Sag Harbor), New York, the goal of acupuncture remains the same today as it was in China thousands of years ago.
This practice is about how energy or qi, flows through the body along a series of channels called meridians—similar to the way nerves and vessels carry messages and blood throughout every system.
“According to Chinese medicine theory, each meridian is related to a specific organ, and placing thin needles at certain points along these meridians can effect certain changes in the body to restore homeostasis,” says Menard. The needles aren’t the type you’d use to draw blood; they’re very thin and flexible, almost like bits of wire.
Placing along meridians can cause changes such as more blood flow or lymphatic fluid going to certain organs, or muscles releasing in a way that lowers the tension on bones and joints..Mikhael explains that the needles could also stimulate nerves, and alter nervous system regulation, which can result in a relaxation response. This relieves pain.
Menard also says that Acupuncture can stimulate the immune and lower inflammation. Both of these effects have potential to bring about benefits for the entire body. Menard said that while relief may be immediate depending on the severity of an injury or condition, most people need several sessions to address chronic issues or more complex problems.
There has been extensive research on acupuncture and strong evidence to support its efficacy for certain conditions. One analysis was published in the February 2022 issue of The. BMJ that analyzed more than 2,000 scientific reviews of acupuncture therapies, the science is strongest behind acupuncture’s efficacy for post-stroke aphasia; neck, shoulder, and muscle pain; fibromyalgia pain; lactation issues after delivery; lower back pain; vascular dementia symptoms; and allergy symptoms.
National Institutes of Health (NIH), finds that acupuncture to relieve pain tends have more evidence than other treatments, particularly for chronic conditions such as osteoarthritis, lower back pain, and tension headaches. The NIH also notes that acupuncture might be able to treat symptoms related to cancer treatment.
That’s been a booming area of interest for the field, says Sarah Weaver, an acupuncturist and massage therapist at Northwestern Health Sciences University in Minnesota, which focuses on integrative health professions, such as acupuncture, chiropractic, and Traditional Chinese Medicine. Session can help with nausea, numbness and tingling (called Neuropathy), as well low appetite and severe and persistent pain.
“Often, people with cancer want to add complementary treatment that doesn’t affect their chemotherapy or radiation, and that’s where an option like acupuncture can be helpful,” she says. “It’s the reason more healthcare systems are bringing this treatment into their integrative care options.”
What’s next in the field
Acupuncture is far from a proven and accepted therapy for most conditions—even for the ones that show promise. That’s in part because the studies that support it are sometimes not high quality, and the field lacks standardized protocols that would better allow it to be scientifically evaluated, the recent WHO report finds.
One 2016 review examined studies that looked at the use of acupuncture to treat substance abuse or addiction. The review included 83 articles. It found significant differences in quality of the studies, needle frequency and length, as well as the points used along meridians. This made it hard to determine how effective acupuncture was. Researchers argue that the field lacks a clear language and an agreement on where acupuncture points are located.
These issues will need to be addressed to gain more understanding and earn the recommendation of reputable organizations. International experts in the field are pushing to make clinical trials more rigorous in order to prove acupuncture’s utility for patient care and to help providers adopt the best practices as more benefits become clear.
The future research directions include looking at how acupuncture can affect hormone regulation. For example, acupuncture could be used to alleviate hot flashes during menopause and treat irregular menstrual cycles. Menard says that research has shown that acupuncture can increase estrogen levels and other hormones. Acupuncture for gynecological problems is also becoming increasingly popular. Some researchers are also focused on studying acupuncture’s impact on fertility; some small, preliminary studies indicate its use may be linked to getting pregnant sooner and having better outcomes from IVF treatments.
Research in Acupuncture and Mental Health is an important area of research, particularly when it comes to how they affect overall health. For example, chronic pain has often been linked to depressive symptoms, so researchers are looking at whether acupuncture can address both: a person’s pain and their depression. The researchers are optimistic. The journal published a study in 2020. Neurology Frontiers found that people with migraines who did acupuncture treatments had a lower risk of depression and anxiety, and tended to use medical services less often, compared to migraine patients who didn’t do acupuncture.
The evidence base is expanding, which will lead to acupuncture growing in popularity. Menard states that although acupuncture is a well-known treatment, there has only been an increase in its acceptance in recent years by Western doctors as well as patients. The treatment could be part of more discussions like Mikhael’s with his patients due to ongoing research and higher interest from the health system.
“At the end of the day, doctors want their patients to feel better, and many people are looking for non-pharmaceutical paths for wellness,” Menard says. “Depending on the condition, those little needles can make a huge impact.”
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