Acupuncture Textbook Pdf

[Martha Vanschaick]

ObjectivesExplain how acupunctures works.Describe the techniques involved in performing acupuncture.Identify patient populations that might benefit from acupuncture.Summarize the clinical impact that acupuncture can have and how the interprofessional team can help coordinate care for patients who might benefit from acupuncture.Access free multiple choice questions on this topic.

Acupuncture is a nonpharmacological treatment option for multiple different diseases and symptoms. Although numerous studies have been done regarding the efficacy of acupuncture, there only been a few landmark high-quality randomized controlled trials. The article mainly focuses on the evidence of these high-quality studies. This in-office procedure has varying degrees of efficacy. Acupuncture treatments include nausea, pain, allergies, hot flashes, breathing difficulty, mood disorders, dyspepsia, and even tobacco use. Acupuncture is mainly safe. Local side effects can occur, but they typically resolve reasonably quickly after removing the acupuncture needle. Acupuncture is most commonly used in the treatment of chronic, noncancer pain in adults.

Although acupuncture originated in TCM, its migration to the West was through other Asian countries, chiefly Korea and Japan. Many consider this a relatively recent movement; however, Osler himself mentioned acupuncture in his writings on medicine in the 1700s. However, acupuncture was considered for some time as a fringe treatment and not part of legitimate medical care. The efficacy of acupuncture is changing. Up to 1.5% of the US population has utilized acupuncture at some point, and the service is even available at many top academic medical centers in the United States. Acupuncture is seldom used as a sole treatment, however, but rather in conjunction or as an adjunct to traditional medical care.

As more studies are done showing the efficacy of acupuncture to treat various types of pain, insurance companies are beginning to take notice. Acupuncture is now an in-office procedure covered by multiple insurance providers. Multiple studies have shown the effectiveness in the treatment of back pain, either acute or chronic, knee pain secondary to osteoarthritis, myofascial pain, and headaches [4][5][6][7]. However, it must be noted that there is a significant placebo effect. There is power in belief. Many studies show not only acupuncture leading to superior pain relief for various ailments but also sham acupuncture. However, given the overall positive patient response, limited side effect profile, and little to no cost on the healthcare system, acupuncture is an essential alternative treatment modality [8][9].

The primary proponent to whether acupuncture should or should not be recommended is the desired to pursue acupuncture therapy from the patient. The first rule of medicine is not to harm. Acupuncture or sham acupuncture makes patients feel better. There is a psychological component to therapy. However, like many medications and treatment modalities, their effectiveness can be directly correlated to the physician or healthcare provider endorsing the treatment. If the provider is seeing a patient with chronic low back pain and is hopeful that acupuncture could help with their pain, the patient is more likely to believe acupuncture will help with her pain. In comparison, if a provider approaches the patient by saying acupuncture does not work, then the patient may not think it works nearly as well.

Given the ideology underlying acupuncture, almost every medical condition has been treated with this modality in the East. Even in western medicine, acupuncture has been attempted and studied in a variety of diseases and disorders, ranging from seasonal allergic rhinitis to fibromyalgia.

There are very few strict contraindications to acupuncture. It has been used even in vulnerable populations, such as in pregnant and pediatric patients. Nausea and vomiting in both of these populations seem to be more effectively improved by acupuncture than in the general population. In general, acupuncture needles are thinner and thus gentler than conventional hollow bore needles such as intravenous (IV) catheters, phlebotomy needles, or neuraxial needles. Anticoagulation is also not a strict contraindication based on this rationale. Most practitioners recommend not undergoing acupuncture if experiencing active infection, especially cutaneous, malignancy, as there might be a threat of the spread of neoplastic cells; and severe neutropenia secondary to the risk of infection. Otherwise, the judgment of the practitioner is considered paramount.

Two specific contraindications deserve special mention: patients with an AICD should avoid any electromagnetic stimulation that might be used as a form of acupuncture. Also, it is not recommended that patients that suffer or are predisposed to suffer from psychosis or delusions undergo acupuncture as well.

People on warfarin or other anticoagulants, as well as people with a history of bleeding disorders, are not contraindications to acupuncture [13]. Pregnancy is also not a contraindication to acupuncture.

In the United States, clinical acupuncturists are credentialed through the American Board of Medical Acupuncture. The National Certification Commission for Acupuncture and Oriental medicine certifies non-clinical acupuncturists. Both of these endorse the requirement for 2000 to 3000 hours of training in a 3- to a 4-year program. Board certification encompasses a final standardized exam and the demonstration of adequate training before certification. Many states allow physicians to practice acupuncture without significant training, and others may require a few hundred hours of additions to training and certification.

Over 30% of patients in the United States who received acupuncture do so in a multidisciplinary setting. Some examples of this could be a natural pathic office. Physical therapy, primary care office, integrative medicine office, and pain clinics. The other 70% is largely a solo practitioner acupuncturist [14][15][14].

Anytime a foreign body is introduced into a patient even on a superficial level, there is no risk of bleeding, local irritation, or infection. Complications of acupuncture were briefly mentioned previously under contraindications; they are the same as with any procedure that involves needles: infection, disease transmission, trauma, nerve injury, and bleeding. Also, dependent upon where the acupuncture is being performed, there is a risk of pneumothorax and pneumoperitoneum or even organ puncture.

Acupuncture has gained popularity as an adjunct to conventional allopathic medical treatments and is offered even at prestigious academic medical centers. However, despite numerous studies, the mechanism for how acupuncture might be functional physiologically is yet to be determined. Hypotheses include that the stimulation influences inflammatory markers induces hormonal changes, or even that the pressure itself manipulates loose connective tissue that causes immunomodulation. It is theorized that analgesia results as well from the release of natural opioids at both spinal or supraspinal levels. Functional MRI has shown physiologic changes in the central nervous system while undergoing acupuncture.[16][17]

It is questionable if acupuncture is clinically superior when compared to sham acupuncture. However, this does not take into the fact both acupuncture and sham are both effective in the reduction of symptoms and improving the function of patients with back pain, headaches, knee pain, and hot flashes. Both therapies are superior to no treatment at all [18][19].

Osteoarthritis is also a ubiquitous problem in the United States. Acupuncture, sham, was shown in one study to be more effective than exercise and equal to medical therapy. However, real acupuncture showed no significant benefit. Further studies also showed acupunctures effectiveness in addition to physical therapy, medical management, and exercise.

Migraine headaches can cause significant morbidity and are often resistant to pharmaceutical treatment alone. Acupuncture has been shown to reduce headache frequency moderately and to create a small reduction in headache intensity. One study demonstrated a more significant decrease in migraine frequency than prophylactic pharmaceutical treatment. Overall, acupuncture also resulted in fewer adverse effects relative to pharmaceutical therapy [23]. The National Institute of health care excellence suggested acupuncture should also be used for either chronic headaches or migraines not responding to pharmacological management.

Overall, acupuncture is considered as valid as antiemetics for the treatment of postoperative nausea and vomiting. The P6 acupoint on the wrist has been identified as the location for this effect. The antiemetic effect is considered less effective for chemotherapy-related nausea and vomiting, but some studies have shown efficacy for this as well.

A thorough Pubmed review will reveal a plethora of studies on the use of acupuncture with many medical conditions and diseases. However, the vast majority have not shown sufficient evidence of efficacy. The requirements outlined above have been examined most closely in regards to the effectiveness of acupuncture.

Even if truly useful, the effects of acupuncture are limited. Acupuncture is often not covered by Medicare or Medicaid or other large, health insurance companies, and thus, represents an added out-of-pocket expense to the patient. However, the risks of this treatment modality are relatively low and, therefore, may be considered an option in the treatment of many refractory and debilitating medical conditions.

Although acupuncture has been commonly used to treat chemotherapy-induced nausea and vomiting as well as pain control in patients with cancer, the efficacy is lacking, and the studies that have been done are poor quality [24].

Multiple studies have shown the use of acupuncture for pregnancy-induced nausea [25]. Acupuncture has been shown to show a 40% reduction in hot flashes. Yet, not superior to sham acupuncture [26]. Studies have also previously been done assessing the usefulness of acupuncture in treating allergic rhinitis. Studies have shown limited to no effectiveness for seasonal symptoms. But, acupuncture can benefit from perennial symptoms of allergies. The effects were considered modest relief of allergy symptoms at a 4-week treatment follow-up [27][28]. The recommendation of the American Academy of Otolaryngology, Head, and Neck Surgery supports the use of acupuncture for allergic rhinitis.

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