East Meets West: Medical Acupuncture in the U.S.

Laura Mitchell's picture
By Laura Mitchell on November 13, 2017

People who suffer from chronic back pain might consult with an orthopaedic specialist, take pain medications and even undergo surgery.
 
Cancer patients with chemotherapy-induced nausea may take multiple powerful medications before and after each treatment to prevent and manage their symptoms.
 
People who quit smoking or other substances are often confronted with insomnia, anxiety and irritability in addition to their cravings.
 
All of these conditionsand many morecan be addressed by another intervention that may surprise some people: medical acupuncture.
 
Practiced for thousands of years throughout Asia, acupuncture is increasingly recognized as an effective complementary therapy for a wide variety of conditions. The World Health Organization reports that controlled trials have shown the following symptoms, diseases and conditions to be treated effectively by acupuncture:

  • Back and neck pain
  • Knee pain, shoulder periarthritis and tennis elbow
  • Headache and craniomandibular disorders
  • Sciatica
  • Sprains
  • Dental pain and temopromandibular (TMJ) dysfunction
  • Rheumatoid arthritis
  • Certain pregnancy-related conditions
  • Nausea and vomiting
  • Adverse reactions to radiation or chemotherapy
  • Postoperative pain
  • Stroke
  • Essential hypertension and primary hypotension
  • Leucopenia
  • Allergic rhinitis, including hay fever
  • Renal and biliary colic
  • Depression
  • Primary dysmenorrhea, or painful periods
  • Certain gastrointestinal conditions, including gastritis, epigastralgia, peptic ulcer and bacillary dysentery

In the U.S., research supported by the National Institutes of Health (NIH) has found medical acupuncture to be effective on its own or as a complementary treatment for a variety of conditions.
 
“Acupuncture is useful by itself or combined with conventional therapies to treat addiction, headaches, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, lower back pain, carpal tunnel syndrome and asthma; and to assist in stroke rehabilitation,” an NIH report states.
 
What Is Acupuncture?
The human body has more than 2,000 acupuncture points. According to Traditional Chinese medicine (TCM), each point connects with a pathway, or meridian, that conducts energy internally to corresponding organs. TCM holds that stimulating those points with fine, flexible, sterile needles regulates spiritual, emotional, mental and physical balance by restoring balance to those pathways and enabling the free flow of energy along them.

two medical dummies showing acupuncture points and meridians
Acupuncture uses specific points on the surface of the body to address internal symptoms and conditions.

 
The meridians described in TCM do not correspond with nerve or blood circulation pathways, and western scientists have developed a range of theories as to how—or whether—the energy pathways exist. What they have found is that acupuncture points stimulate the central nervous system to release chemicals and hormones that stimulate the body’s natural healing abilities and change the way a patient experiences their pain.
 
The American Academy of Medical Acupuncture describes several mechanisms that may apply in response to acupuncture:

  • Conduction of electromagnetic signals that release pain-killing biochemicals (such as endorphins) and immune system cells to injured or vulnerable sites
  • Activation of internal opioid systems
  • Changes in brain chemistry sensation, such as by changing the release of neurotransmitters and neurohormones, and involuntary body functions, such as immune reactions and the regulation of blood pressure, blood flow and temperature

Medical Acupuncture in the U.S.
Priscilla Tu, D.O., is a family medicine physician with Carilion Clinic who is also trained in medical acupuncture. She explained the difference between a licensed acupuncturist and a medical acupuncture provider.
 
“Some states allow anyone to call themselves an acupuncturist, even without any training,” she said. “In Virginia, a licensed acupuncturist does have to have some training, but they may or may not have a medical background.”
 
In contrast, a medical acupuncture provider is a licensed physician who undergoes extensive additional training and must be certified by the American Board of Medical Acupuncture (ABMA). The standards set by the ABMA exceed those set by international health organizations such as the WHO.
 
The Helms Medical Institute, where Dr. Tu received her training, is involved in acupuncture research with the U.S. military, where battlefield acupuncture has become popular.
 
“Battlefield acupuncture is all ear-based,” she said. “It can be applied for pain or during transfer. There is also a lot of acupuncture research now regarding post-traumatic stress disorder.”
 
Acupuncture Treatment
A course of medical acupuncture begins with an hour-long consult with a patient who has been referred by their provider. Dr. Tu considers the patient’s diagnoses as well as their overall biological condition and type, their psychological condition and their goals. She then recommends a series of treatments that are customized in number and length to that patient.
 
“Each treatment can be as short as 30 minutes, or as long as an hour,” said Dr. Tu. “The needles are inserted for at least 10 minutes, with some staying in place for up to 30 minutes.”
 
Unlike hypodermic needles used to draw blood, acupuncture needles are hair-thin with smooth tips. They cause minimal pain, if any, when inserted, and no discomfort while they are in place.

acupuncture needle next to hypodermic needle
Acupuncture needles are much smaller and smoother, and therefore much less painful, than hypodermic needles.

 The needles may be left in place, manipulated or warmed, depending on the treatment goals. Because there are so many traditions and variations to acupuncture, treatment options can be highly subjective.
 
“Treatments are personalized to a patient’s needs on the day of treatment,” said Dr. Tu. “Ten medical acupuncturists trained by the same institution may take 10 different approaches to the same person and condition.”
 
People experience acupuncture needling differently. Some people are energized by treatment, while others feel relaxed. To gain the most benefit from acupuncture treatments, the National Center for Complementary and Integrative Health at NIH recommends the following guidelines:

  • Avoid large meals immediately before or after your treatment
  • Avoid alcohol, sexual activity and strenuous exercise for six hours before and after treatments (substance abuse will seriously interfere with the effectiveness of acupuncture treatments)
  • Arrange to rest, or not perform at peak levels, after treatments, especially for your first few visits
  • Continue to take prescription medicines as directed by your health care providers
  • Keep good mental or written notes of your responses to your treatments and discuss them with your provider

A patient does not need to “believe” in acupuncture for it to be effective. However, like many other medical interventions, it does not work for everyone.
 
“Ten to 15 percent of people don’t respond to acupuncture at all,” said Dr. Tu. “I can usually tell in the first session or two how effective it will be for the patient.”
 
Don’t Try This at Home
For acupuncture to be effective and safe, it must be conducted by a trained medical provider who is certified in medical acupuncture and understands a patient’s underlying physiological and psychological conditions.
 
However, there are some acupressure opportunities that people may try on their own.
 
“Sea Bands were developed from acupressure principles,” said Dr. Tu. Used on the wrist, the product is designed to help with nausea for pregnant women and people who experience carsickness or seasickness.
 
As with battlefield acupuncture, nurses and even patients can be trained to apply pressure to points on the ear to treat acute pain.

human ear showing acupuncture acupressure points
The human ear contains many effective acupuncture points.

 “There is a lot you can do with the ear and the scalp,” said Dr. Tu. "There are some headache points you can teach people.”
 
She emphasizes the importance of training.
 
“Certain areas on the scalp are sensory in nature, while others affect motor, balance or vision,” she said.
 
Someone who is already feeling pain can inadvertently stimulate a point that affects their balance, resulting in dizziness instead of relieving their headache.
 
Health care providers are recognizing the benefits of medical acupuncture more and more, but it is not always top of mind when they consider potential treatments for their patients. If you think medical acupuncture may help you, consult with your primary care provider.