Shaftesbury Clinic Star of Conditions

Rheumatoid Arthritis – Condition Resources

Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

Rheumatoid Arthritis is a chronic inflammatory disorder, primarily affecting the joints in the body. It can have a pattern of relapses and remissions, and pain and inflammation are some of the primary symptoms that patients are looking to address.

About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.

Studies

Feng et al (2023) conducted a systematic review and meta-analysis of 17 RCTs comparing electroacupuncture (EA) plus medication with other treatments, such as medication alone, or sham acupuncture for Rheumatoid Arthritis. Measures of clinical efficacy, pain scores (visual analogue scale, VAS), disease activity score in 28 joints (DAS28), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and adverse events were compared. The results showed that EA plus medication had a superior effect than medication alone or other treatments, in improving clinical efficacy, VAS, DAS28, CRP, and ESR. The authors concluded that EA plus medication is an effective and safe treatment for RA, but more high-quality studies are needed to confirm its long-term benefits and mechanisms.

Electroacupuncture has been shown to alleviate symptomatic knee pain in rheumatoid arthritis (Casimiro et al 2005; Cochrane review).

A systematic review and meta-analysis of 21 animal studies (Yu et al, 2023) investigated acupuncture’s effect on pain and swelling of arthritis animal models. Acupuncture was found to increase tolerance to pain stimuli and reduce swelling in arthritis animals, the researchers suggested possible mechanisms of action as being via nervous and immune system regulation.

Mechanisms of Action:

A review article (Kavoussi & Ross, 2007) suggests that the anti-inflammatory actions that have been demonstrated to be brought about by acupuncture may be mediated via activation of the vagus nerve, alongside deactivation of inflammatory macrophages and other proinflammatory cytokines.  The researchers concluded that “The use of acupuncture as an adjunct therapy to conventional medical treatment for a number of chronic inflammatory and autoimmune diseases seems plausible and should be validated by confirming its cholinergicity”. 

Other studies (Zijlstra et al, 2003) have revealed that acupuncture some of the pain modulating and anti-inflammatory effects seen in acupuncture trials may be due to the fact that it has been shown to stimulate certain substances in the body which act as vasodilators, neurotransmitters and painkillers (beta-endorphins, CGRP and substance P) and further stimulate cytokines and nitric oxide, all of which play roles in inflammatory states. 

Zijlstra et al (2003) reviewed the effects and mechanisms of acupuncture in treating various inflammatory diseases and conditions. They proposed the mechanisms of action:

  • Acupuncture may release neuropeptides from nerve endings that have vasodilative and anti-inflammatory effects through CGRP.
  • Acupuncture may also interact with substance P, which is involved in pain transmission and inflammation.
  • Acupuncture may contribute to analgesia by stimulating the release of β-endorphin, which binds to opioid receptors and inhibits pain signals.
  • Acupuncture may influence the balance between cell-specific pro-inflammatory and anti-inflammatory cytokines such as TNF-α and IL-10.

CSR and ERP are blood tests related to the functioning of the immune system, that can measure and monitor inflammation in the body.  They are relevant to conditions such as Rheumatoid Arthritis, and other immune and inflammatory conditions.  Per a review by Feng at al, (2023) electroacupuncture (EA) plus medication had a significant effect in lowering both ESR and CRP levels in patients with RA compared with medication alone.  These results suggest that EA may have an anti-inflammatory effect and improve the immune status of patients with RA.

Inflammatory and immune markers:  Wang et al (2008) reviewed the evidence from 8 RCTs for acupuncture as a treatment for rheumatoid arthritis (RA) that compared acupuncture with placebo or active drug interventions. Five studies observed a reduction in the inflammatory/immune marker of ESR and three noted a reduction in CRP level after acupuncture treatment.

Acupuncture can activate mast cells at acupoints, which release histamine, serotonin, adenosine, and other mediators that modulate nerve transmission and inflammation (Li et al, 2022)

Wang et al (2023) reviewed evidence from animal and human studies regarding the immunomodulatory mechanism of acupuncture, regarding its effects on different components of the immune system, such as mast cells, macrophages, neutrophils, natural killer cells, astrocytes, microglia, CD4+ and CD8+ T cells, and cytokines.  They detailed the neuroanatomical mechanisms of acupuncture in immunomodulation, such as the vagal-adrenal pathway, the cholinergic anti-inflammatory pathway, the spinal sympathetic pathway, the brain-gut axis, and the hypothalamus-pituitary-adrenal axis.  They concluded that studies to support the role of acupuncture in regulating inflammation, infection, allergy, pain, and tissue repair.

Acupuncture has also been shown in human research trials, to downregulate the areas of the brain associated with sensitivity to pain and stress, which may also contribute to its contribution to addressing pain issues (Hui et al, 2010).

Animal Models

Specifically acupuncture in an animal model has also demonstrated improvement in inflamed synovium which is characteristic of Rheumatoid Arthritis (He et al, 2010).

An animal model study (Sun et al, 2023; n=36) investigated the effects of electroacupuncture (EA) on rheumatoid arthritis (RA) in rats, plus its underlying mechanisms. They showed that acupuncture helped RA outcome measures of paw oedema, pain responses, serum cytokines, synovial inflammation, in collagen-induced arthritis (CIA) rats.  They were able to show that RA worked by blocking a pathway in the synovium called TLR2/4, that activates immune response and inflammation.  The researchers therefore suggested the anti-inflammatory and analgesic effects of EA were related to the inhibition of TLR2/4 signalling on synovial fibroblasts and macrophages.

Inflammation modulation: Liu et al (2014) investigated the anti-inflammatory effect of electroacupuncture (EA) in a rat tissue chamber model of inflammation. The study found that EA inhibited the p65 protein from moving to the cell nucleus to activate inflammatory genes.  EA also increased the expression of IκBα, which binds to NF-κB and preventing it from entering the nucleus to activate inflammatory genes. These interfere with the IκB/NF-κB pathway that regulates inflammation, indicating one of the mechanisms of acupuncture in modulating immune / inflammatory response.

Electroacupuncture (EA) has been shown in a rat model (Li et al, 2008) to have anti-inflammatory benefits by modulating the hypothalamic-pituitary-adrenal (HPA) axis, (HPA axis regulates the stress response and immune function).  Specifically, Li et al outlined that EA sets off a cascade in the brain (via corticotropin-releasing hormone, and adrenocorticotropic hormone) to produce cortisol, which reduces inflammation and oedema.

References:

Casimiro, L., Barnsley, L., Brosseau, L., Milne, S., Welch, V., Tugwell, P. and Wells, G.A., 2005. Acupuncture and electroacupuncture for the treatment of rheumatoid arthritis. Cochrane Database of Systematic Reviews, (4).

Feng, Y., Zhang, R., Zhao, Z., He, Y., Pang, X., Wang, D. and Sun, Z., 2023. Efficacy and safety of electroacupuncture combined with medication for rheumatoid arthritis: A systematic review and meta-analysis. Heliyon.

Kavoussi B, Ross BE. The neuroimmune basis of anti-inflammatory acupuncture. Integr Cancer Ther 2007;  6:  251-7.

He, T.F., Zhang, S.H., Li, L.B., Yang, W.J., Zhu, J. and Chen, Y.F., 2010. Effects of acupuncture on the number and degranulation ratio of mast cells and expression of tryptase in synovium of rats with adjuvant arthritis. Zhong xi yi jie he xue bao= Journal of Chinese integrative medicine8(7), pp.670-677.

Hui, K.K., Marina, O., Liu, J., Rosen, B.R. and Kwong, K.K., 2010. Acupuncture, the limbic system, and the anticorrelated networks of the brain. Autonomic Neuroscience157(1-2), pp.81-90.

Li, A., Lao, L., Wang, Y., Xin, J., Ren, K., Berman, B.M., Tan, M. and Zhang, R., 2008. Electroacupuncture activates corticotrophin-releasing hormone-containing neurons in the paraventricular nucleus of the hypothalammus to alleviate edema in a rat model of inflammation. BMC Complementary and Alternative Medicine8(1), pp.1-8.

Li, Y., Yu, Y., Liu, Y. and Yao, W., 2022. Mast cells and acupuncture analgesia. Cells11(5), p.860.

Liu, F., Fang, J., Shao, X., Liang, Y., Wu, Y. and Jin, Y., 2014. Electroacupuncture exerts an anti-inflammatory effect in a rat tissue chamber model of inflammation via suppression of NF-κB activation. Acupuncture in Medicine32(4), pp.340-345.

MacPherson H, Blackwell R, 1994. Rheumatoid Arthritis and Chinese Medicine: a Review. European J of Oriental Medicine 1(3) 17-29

Sun, S.Y., Yan, Q.Q., Qiao, L.N., Shi, Y.N., Tan, L.H. and Yang, Y.S., 2023. Electroacupuncture Alleviates Pain Responses and Inflammation in Collagen-Induced Arthritis Rats via Suppressing the TLR2/4-MyD88-NF-κB Signaling Pathway. Evidence-Based Complementary and Alternative Medicine2023.

Wang, C., De Pablo, P., Chen, X., Schmid, C. and McAlindon, T., 2008. Acupuncture for pain relief in patients with rheumatoid arthritis: a systematic review. Arthritis Care & Research: Official Journal of the American College of Rheumatology59(9), pp.1249-1256.

Wang, M., Liu, W., Ge, J. and Liu, S., 2023. The immunomodulatory mechanisms for acupuncture practice. Frontiers in Immunology14.

Yu, W.L. and Kim, S.N., 2023. The effect of acupuncture on pain and swelling of arthritis animal models: A systematic review and meta-analysis. Frontiers in Genetics14.

Zijlstra, F.J., van den Berg-de Lange, I., Huygen, F.J. and Klein, J., 2003. Anti-inflammatory actions of acupuncture. Mediators of inflammation, 12(2), pp.59-69.

Helen
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The importance of integrated working

Some common questions on how we work alongside allopathic medicine

“But what will my doctor say?”

Take a look at Helen Smallwood’s video about this exact question, which shows that acupuncture is popular, and that research has shown that it is well-supported by medical professionals.

Studies have shown that majority (83%) of GPs agree acupuncture can be clinically useful and 72% that it can be cost effective. (Lipman et al, 2003), and 65% agree acupuncture is effective (White, Resch, & Ernst 1997).  In a study by the British Medical Association

“Overall 79% of the GPs agreed that they would like to see acupuncture available on the NHS” (BMA, 2000 p76).

Where GPs recommend acupuncture to patients, it is mostly for pain relief, musculoskeletal disorders, psychological conditions, stress, skin diseases and chronic illnesses (BMA, 2000; Giannelli, Cuttini, Da Fre & Buiatti, 2007; Adams 2001a; Ernst 2000b; Desser, 2003, Lewis & Halvorsen, 2003). Their support is shown by the fact that between 59% (BMA, 2000) and 79% (Lipman, 2000) of GPs would like to see acupuncture available within the NHS.

Chen et al, in a survey of doctors (2010; n=1083 physicians, USA) found that the overwhelming majority of replies from doctors had a positive attitude and favourable experience of using acupuncture for patients’ chronic pain management. Similarly a later study showed acupuncture is considered a useful modality by physician leaders, that it is a safe and worthwhile option for common pain conditions (Mann et al, 2016).

Read More The importance of integrated working

Helen
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Shaftesbury Clinic Star of Conditions

Urinary Incontinence – Condition Resources

Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

The British Acupuncture Council has looked at some recent trials in its research digest (see link below), including an RCT (n= 504 over 12 hospitals – multicentre trial; Lu et al, 2017), which found a positive trend in less urine leakage for the acupuncture group after 6 weeks for women with stress urinary incontinence.

A systematic review and meta-analysis of 10 RCTs (n=794 in total) found acupuncture may decrease micturation (urination) episodes, night time urination and improve patients’ quality of life, although further research was warranted (Zhao et al, 2018)

For more information on the urinary system and acupuncture, see our dedicated page on Bladder Issues

About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.

References:

Liu, Z., Liu, Y., Xu, H., He, L., Chen, Y., Fu, L., Li, N., Lu, Y., Su, T., Sun, J. and Wang, J., 2017. Effect of electroacupuncture on urinary leakage among women with stress urinary incontinence: a randomized clinical trial. Jama317(24), pp.2493-2501.

Zhao, Y., Zhou, J., Mo, Q., Wang, Y., Yu, J. and Liu, Z., 2018. Acupuncture for adults with overactive bladder: a systematic review and meta-analysis of randomized controlled trials. Medicine97(8).

Resources:

British Acupuncture Council evidence based factsheet about Urinary Incontinence including specific research, trials and mechanisms of action for acupuncture in this condition.

British Acupuncture Council Research digest – Urinary Incontinence (just over halfway down the document)

Helen
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Shaftesbury Clinic Star of Conditions

Vertigo and Dizziness – Condition Resources

Page under construction

Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.

Resources: British Acupuncture Council evidence based factsheet about Vertigo and Dizziness including specific research, trials and mechanisms of action for acupuncture in this condition.

Helen
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Shaftesbury Clinic Star of Conditions

Weight Loss – Condition Resources

Page under construction

Our page on Obesity may be of assistance

Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.

References:

British Acupuncture Council evidence based factsheet about Obesity including specific research, trials and mechanisms of action for acupuncture in this condition.

British Acupuncture Council evidence based factsheet about Addictions including specific research, trials and mechanisms of action for acupuncture in this condition.

Helen
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Shaftesbury Clinic Star of Conditions

Celebrity Endorsement Information

A number of celebrities have spoken out about their own use of acupuncture to support and publicise it.

Here are a few highlights:

Camilla Dallerup (Strictly Come Dancing professional) has been interviewed and shown having acupuncture – view it here

TV presenter and Style Editor Donna Air was also interviewed about acupuncture, recommending it and using a BAcC member for treatment, and you can watch it here

Gwyneth Paltrow was filmed in 2018 undergoing an acupuncture session with her acupuncturist in New York, you can view it here.

Madonna has shared photographs of herself on Instagram (social media) having acupuncture and cupping (an acupuncture adjunct).

Jim Carrey, (2013) said that undergoing acupuncture treatments lead to marked change in his physical vitality and general state of wellbeing.

Robert Downey Jr. is also a long-time user and public advocate of acupuncture and Chinese Medicine.

Singer Alicia Keys has also been quoted as saying that acupuncture helps her to unwind and balance energy her body.

Jennifer Aniston has spoken of how she finds acupuncture beneficial in wellbeing and countering stress.

Sandra Bullock is also a fan of acupuncture, reportedly having an on-set acupuncturist whilst filming in some of her roles.

Athletes

Professional wrestler Brian Cage is a fan of cupping (an acupuncture adjunct), and has was seen with the easily identifiable cupping marks* on his back in the ring in 2019, at a time he was looking to address a back injury. *Cupping causes local microtrauma as part of its therapeutic approach, and therefore temporary red circles on the areas applied (often the back).

The National Geographic (2018) featured photos of professional American Footballer and Super Bowl star, James Harrison sporting a large number of (acupuncture) cups on his chest and back, revealing in his interview that weekly acupuncture is a vital part of his routine in looking after his physique, another photograph depicts Harrison lying prone with a large number of needles through his back, shoulders and legs.

Fertility:

Celine Dion and Mariah Carey have both gone on record to speak about using acupuncture when they were looking to conceive. Celine was using IVF in order to conceive and looked to acupuncture as a complementary approach alongside it. Mariah explained that Celine had advised her to try acupuncture, and that is was beneficial to her wellbeing and stress reduction and she credits this as helping her achieve a pregnancy, alongside hormone treatments.

Geri Horner (nee Haliwell, of the Spice Girls), has also stated in the press that she had used acupuncture in support of her looking to conceive her son.

Facial Acupuncture

Celebrities who have shared photos of themselves receiving facial acupuncture (with needles in situ), on their social media or in the press include: Kim Kardashian, Jessica Alba, Millie Mackintosh, Gwyneth Paltrow, David Duchovny and newspaper columnist Lynsey Clarke. 

Singer Katy Perry was featured in her music video “Never Really Over” sporting facial acupuncture needles in her face (whilst singing) and receiving a tradition acupuncture adjunct of cupping therapy (an adjunct to acupuncture).  

Helen
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Shaftesbury Clinic Star of Conditions

Women’s Health – Condition Resources

Acupuncture is a popular choice for women for a number of issues relating to the menstrual cycle, fertility, pregnancy, post-partum and the menopause.

Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

Acupuncture is safe in pregnancy, but do ensure you tell your midwife (and consultant if you are under one) that you’re using it, and also tell your acupuncturist, as there are certain points which must be avoided in pregnancy.

Below (under Resources) is a list of specific conditions for which the British Acupuncture Council (BAcC) has produced evidence-based factsheets regarding women’s health.

The BAcC has also produced a paper on gynaecology and acupuncture, which in addition looks at the use and evidence of effectiveness of acupuncture in dysmenorrhoea, dysfunctional uterine bleeding and chronic pelvic inflammatory disease, where the BAcC concluded that there is a growing body of evidence to support the value of acupuncture in addressing these gynaecological conditions.

About the research:

It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.

Mechanisms of action:

Acupuncture has also been shown to affect certain areas of the brain, which influence particular hormones involved in the menstrual cycle. It is thought that acupuncture balances the hormonal system by controlling the hypothalamic-pituitary-adrenal (HPA) axis. The hormones and neurotransmitters that have been shown to be thus influenced in scientific studies include:

  • Gonadotrophin releasing hormone (GnRH)
  • Lutenising hormone (LH)
  • Cortisone
  • Follicle Stimulaitng Hormone (FSH)
  • Prolactin (PRL)
  • Oestrogen uptake
  • Testosterone levels
  • Beta-endorphin levels

See our Fertility and Pregnancy page for full details on the studies and mechanisms of the above.

Resources:

The British Acupuncture Council has several relevant evidence based factsheets about Women’s Health, including specific research, trials and mechanisms of action for acupuncture in these conditions.

BAcC Childbirth and acupuncture factsheet

BAcC Dysmenorrhoea (painful periods) and acupuncture factsheet

BAcC Diabetes (includes Gestational Diabetes)

BAcC Endometriosis and acupuncture factsheet

BAcC Female Fertility and acupuncture factsheet

BAcC Fertility and IVF briefing paper

BAcC Menopausal Symptoms and acupuncture factsheet

BAcC Obstetrics (pregnancy and childbirth) and acupuncture factsheet

BAcC PCOS (Polycystic Ovarian Syndrome) and acupuncture factsheet

BAcC Premenstrual Syndrome and acupuncture factsheet

BAcC Puerperium (postnatal / postpartum) acupuncture factsheet

The British Acupuncture Council also has a review paper on Gynaecology and acupuncture: The evidence for effectiveness

Our own page on Fertility, Pregnancy and Acupuncture

Our own blog on Acupuncture and Menopause

Helen
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Shaftesbury Clinic Star of Conditions

Trigeminal Neuralgia – Condition Resources

Page under construction

Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

Our page on TMJ disorder and pain may be of assistance whilst we construct this page.

References:

Helen
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