Acupuncture

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Acupuncture

Acupuncture is the key therapeutic modality in the ancient Chinese medical

tradition that analyzes disease as a disruption of a patient's vital energy

(qi or chi). The application of needles transcutaneously, sometimes with

ancillary electrical current, heat, or moxibustion (i.e., incense burning),

is intended to restore the balance of vital energy in the patient. According

to Chinese practice, there are 12 primary and 8 extraordinary energy

channels or meridians within the body. The acupuncturist analyzes the

patient's illness in a variety of ways and then selects the sites for needle

insertion.

There appears to be reason to believe that acupuncture may benefit

fibromyalgia patients if appropriate limits are set on the duration of the

trial for individual patients, however further research is necessary before

acupuncture can be recommended with any degree of enthusiasm or strong

scientific basis.

Because the most obvious application of acupuncture to patients with

arthritis or fibromyalgia is to relieve pain, there has been significant

research over the past 20 years on the mechanisms in Western terms that

might explain the relief of pain by acupuncture needles. Many different

studies have shown that reduction in pain may result from release of

endogenous endorphins by acupuncture needling. Naloxone and other opiate

antagonists block acupuncture pain relief. Animals deficient in opiate

receptors or endorphins show a poor response to acupuncture. Additional

studies have demonstrated other hormone release by acupuncture (such as

serotonin and substance P) that may have relevance to the mechanisms of pain

relief.

There have been studies in the use of acupuncture in osteoarthritis. It is

clear that acupuncture can produce pain relief in this disease. In

combination with patient education and exercise, the pain relief from

acupuncture may provide an improvement in quality of life for patients.

There are insufficient studies of maintenance programs with acupuncture to

know how this additional modality should be used over the long term of this

slowly progressive disease. Similarly, it will be important to assess

whether acupuncture delays intra-articular therapies if the latter prove

effective. At the present time, consideration of acupuncture in the

treatment of painful rheumatic conditions should only be at the

recommendation of a rheumatologist or orthopedic surgeon knowledgeable of

the benefit/risk ratio and with a working relationship with an

acupuncturist.