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Acupuncture

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Acupuncture, a therapy within traditional Chinese medicine, is one of the most widely accepted alternative therapies in the western world. Specific points on the body are stimulated, usually by inserting thin needles into the skin and underlying tissues. Stimulating these specific points is believed to unblock the flow of qi along energy pathways (meridians) and thus restore balance. In classic acupuncture, there were365 defined points that corresponded to the 365 days of the year and reflected the historical connection between acupuncture and astrology. Over time, the number of points has increased to > 2000.

The procedure is generally not painful but may cause a tingling sensation. Sometimes stimulation is increased by twisting or warming the needle.

Acupuncture points may also be stimulated by

  • Pressure (called acupressure)

  • Lasers

  • Ultrasound

  • A very low voltage electrical current (called electroacupuncture) applied to the needle

Evidence and Uses

Despite extensive study, no high-quality evidence supports clinically meaningful efficacy of acupuncture for any indication. High-quality studies compare true (verum) acupuncture with sham acupuncture (needle insertion at points not used in acupuncture) or placebo acupuncture (use of opaque sheaths containing a blunt needle or toothpick that is pressed against the skin but not inserted). Because placebo acupuncture studies also use opaque sheaths for true acupuncture, neither patient nor acupuncturist know which treatment is being used (double-blinding). Such high-quality studies generally show no differences in efficacy. Therefore, the best evidence indicates that neither where the needle is inserted nor whether it is inserted affect outcome and that acupuncture has only nonspecific placebo effects.

In some cultures, publication bias tends to favor efficacy for acupuncture; for example, 99% of studies published in China supported efficacy, despite a worldwide average of about 75%. Thus, positive results of existing studies should be interpreted carefully.

Systematic reviews of acupuncture for pain, the most commonly promoted indication, show either no differences between verum, sham, and placebo acupuncture or a small statistical difference that is clinically insignificant or imperceptible. Proponents also claim efficacy of acupuncture for specific disorders (eg, carpal tunnel syndrome, addiction, asthma, stroke, RA); however, in all cases, systematic reviews conclude that the evidence is negative or that methodology is too poor to produce conclusive results.

Possible Adverse Effects and Contraindications

Reliable data are uncommon and often nonexistent, and adverse effects of acupuncture are probably underreported. A 2012 review1 of adverse effects that were reported after acupuncture noted the following:

  • Retained needles (31%)

  • Dizziness (30%)

  • Loss of consciousness or unresponsiveness (19%)

  • Falls (4%)

  • Bruising or soreness at the needle site (2%)

  • Pneumothorax (1%)

  • Other adverse effects (12%)

Most (95%) were classified as causing little or no harm.

When correctly done, acupuncture is fairly safe, but skill and care vary among practitioners; also, some do not follow antiseptic standards.

  • 1 Wheway J, Agbabiaka TB, Ernst E: Patient safety incidents from acupuncture treatments: a review of reports to the National Patient Safety Agency. Int J Risk Saf Med 24(3):163–9, 2012.

* This is the Professional Version. *