Tag Archives: Acupuncture

Acupuncture for COPD Emphysema

COPD – Condition Resources

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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.

Chronic obstructive pulmonary disease (COPD) is group of lung diseases where the airways become permanently narrowed, making it difficult to empty air out of the lungs. It also known as emphysema.

Research and Resources on COPD and Acupuncture:

A scholarly search of the available research papers on the terms “acupuncture” + “COPD” OR “emphysema” yields over 11,800 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives over 1090 results; of which 39% have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used traditionally and currently in this area, research is being done, the pace of which is increasing in recent years, and as such there is a recognition of a need to scientifically appraise any merit it may have in the field.

The British Acupuncture Council has produced an evidence based factsheet about COPD including specific research, trials and mechanisms of action for acupuncture in this condition.

Interpreting the research:

When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

The Research:

This is an area of research with fewer RCT’s than many other areas of acupuncture so far, although the pace of research is increasing. There have been systematic reviews in this area, including one which concluded that health-related quality of life (HRQL) improvements were seen in COPD patients receiving body acupuncture therapy (Hsieh et al, 2019), improved quality of life was also a conclusion in XIao et al’s (2020) systematic review of 11 RCT’s.

However in terms of addressing symptomatic issues, Wang et al, (2018) looked at 19 RCT’s and whilst there were positive trends in some areas of symptoms, further high-quality RCT’s were called for in order to draw stronger conclusions. A more recent systematic review (Fernández-Jané et al, 2020) looking at acupuncture techniques in this field reached the same conclusion as Wang et al, as did von Trott et al (2020) regarding breathlessness and exercise tolerance in 12 studies, again seeing a positive trend in acupuncture groups, but noting the RCT’s examined overall were low-powered and further quality research warranted. Chu et al (2021) also concurred with this in their recent review of systematic reviews.

Recently Wang et al (2021) put forward a protocol for a systematic review of moxibustion (acupuncture adjunct technique) in COPD – the forthcoming result will be of interest.

Regarding Your Individual Condition and Symptoms:

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response.  We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation.  For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

Resources:

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

References:

Chun, L., Li, X., Feng, Z., Xie, Y. and Li, J., 2021. Role of Acupuncture in the Treatment of COPD: An Overview of Systematic Reviews. International Journal of General Medicine, 14, p.1079.

Fernández-Jané, C., Vilaró, J., Fei, Y., Wang, C., Liu, J., Huang, N., Xia, R., Tian, X., Hu, R., Wen, L. and Yu, M., 2020. Acupuncture techniques for COPD: a systematic review. BMC complementary medicine and therapies, 20, pp.1-18.

Hsieh, P.C., Yang, M.C., Wu, Y.K., Chen, H.Y., Tzeng, I.S., Hsu, P.S., Lee, C.T., Chen, C.L. and Lan, C.C., 2019. Acupuncture therapy improves health-related quality of life in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Complementary therapies in clinical practice, 35, pp.208-218.

von Trott, P., Oei, S.L. and Ramsenthaler, C., 2020. Acupuncture for breathlessness in advanced diseases: a systematic review and meta-analysis. Journal of pain and symptom management, 59(2), pp.327-338.

Wang, J., Li, J., Yu, X. and Xie, Y., 2018. Acupuncture therapy for functional effects and quality of life in COPD patients: a systematic review and meta-analysis. BioMed research international, 2018.

Wang, Y., Huang, M., Tang, L., Xu, L., Wu, J., Wang, F. and Zhang, Y., 2021. Moxibustion for stable chronic obstructive pulmonary disease: A protocol for systematic review and meta-analysis. Medicine, 100(17).

Helen
Posted on: May-16-2016 8:24 am
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Shaftesbury Clinic Star of Conditions

Colds & Flu – Condition Resources

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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.

Research and Resources on Colds, Flu, and Acupuncture:

A scholarly search of the available research papers on the terms “acupuncture” + “colds” OR “flu” yields over 15,800 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives over 800 results; of which 27% have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used traditionally and currently in this area, this is an area of increasing research, and therefore an examination of its potential role could be useful.

Interpreting the research:

When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

Regarding Your Individual Condition and Symptoms:

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response.  We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation.  For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

Resources:

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

Helen
Posted on: May-16-2016 8:20 am
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Acupuncture for Chronic Fatigue

Chronic Fatigue Syndrome (CFS / ME) – Condition Resources

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Chronic Fatigue Syndrome (CFS) is also known as Myalgic Encephalomyelitis (ME).

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.

A scholarly search of the available research papers on the terms “acupuncture” + “chronic fatigue” yields over 11,500 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives over 1,200 results; of which one third of these have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used traditionally and currently in this area, research has been carried out, the pace of which is increasing in recent years, and as such that it has been recognised its potential role is worthy of appraisal in a scientific manner.

Interpreting the research:

When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

The Research:

A number of systematic reviews have been carried out in this area, these include Wang, T. et al (2017, 31 RCT’s); Wang, J.J. et al, (2009, 28 RCT’s); Yin et al, (2020, 10 RCT’s); Kim et al, (2017, 11 RCT’s); Son (2009, 53 RCT’s); all concluded along the lines that whist overall the trends appeared positive, this is a tentative conclusion as further studies are needed due to the fact that a number of RCT’s examined suffer from poor quality research design; and in some cases findings were contradictory.

A protocol for a systematic review on the efficacy and safety of moxibustion for chronic fatigue syndrome was published this year (Xue et al, 2021), this will be of interest as moxibustion is the using of a warming herb on acupuncture points (commonly employed by traditional acupuncturists as an adjunct to acupuncture treatment). Furthermore, a protocol for an overview of systematic reviews in this area has been published recently (Tang et al, 2021), the forthcoming result of this will be of interest within the context of the existing research body.

Mechanisms of action:

Acupuncture studies have shown it can: provide pain relief by stimulating nerves in body tissues and leading to endorphin release (natural painkilling substances), as well as downregulating the brain and nervous system’s reaction to stress and pain (Zhao 2008; Zijlstra et al, 2003; Pomeranz, 1987).

Acupuncture stimulates the body to create its own natural painkilling substances, such as Beta Endorphins (β-Endorphin). In studies acupuncture has been shown to stimulate the production of natural painkillers called opioid-like peptides (OLPs), including β-Endorphin: For example, this was shown in an RCT in 90 patients with a range of painful disorders (Petti et al, 1998). The same study showed acupuncture also and enhanced the activity of immune cells (lymphocytes, natural killer cells and monocytes) that help fight infections and diseases (Petti et al, 1998).

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)

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 influence the balance between cell-specific pro-inflammatory and anti-inflammatory cytokines such as TNF-α and IL-10.

Acupuncture has been shown in animal models to promote the release of factors that involved in the reduction of inflammation (vascular and immunomodulatory factors – (Kim et al, 2008; Kavoussi and Ross, 2007 [review article]; Zijlstra et al, 2003), and also to affect levels of serotonin (in an animal model), and other peptides in the brain and nervous system and modulate blood flow in the brain and elsewhere in the body, in humans (Zhong and Li, 2007; Shi et al, 2010).

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.

Regarding Your Individual Condition and Symptoms:

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response.  We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation.  For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

Resources:

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

References:

Kavoussi B, Ross BE. The neuroimmune basis of anti-inflammatory acupuncture. Integr Cancer Ther. 2007 Sep;6(3):251-7.

Kim HW, Uh DK, Yoon SY et al. Low-frequency electroacupuncture suppresses carrageenan-induced paw inflammation in mice via sympathetic post-ganglionic neurons, while high-frequency EA suppression is mediated by the sympathoadrenal medullary axis. Brain Res Bull. 2008 Mar 28;75(5):698-705.

Kim, H.G., Ryoo, D.W., Jeong, S.M., Kim, S.J., Baek, S.W., Lee, C.H., Yoon, J.Y., Goo, B.H., Kim, M.J., Park, Y.C. and Seo, B.K., 만성피로증후군에 대한 침치료의 체계적 문헌 고찰 A Systematic Review of Acupuncture for Chronic Fatigue Syndrome. Journal of Acupuncture Research Volume 34 Issue 2 / Pages.93-112 / 2017

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 Medicine, 8(1), pp.1-8.

Li, Y., Yu, Y., Liu, Y. and Yao, W., 2022. Mast cells and acupuncture analgesia. Cells, 11(5), p.860.

McAteer, R., Skef, S. and Wilson, S., 2019. What nonpharmacologic treatments have shown to be effective for systemic exertion intolerance disease (chronic fatigue syndrome)?. Evidence-Based Practice, 22(2), pp.12-14.

Petti, F.., Bangrazi, A., Liguori, A., Reale, G. and Ippoliti, F., 1998. Effects of acupuncture on immune response related to opioid-like peptides. Journal of Traditional Chinese Medicine 18(1), pp.55-63.

Pomeranz B. Scientific basis of acupuncture. In: Stux G, Pomeranz B, eds. Acupuncture Textbook and Atlas. Heidelberg: Springer-Verlag; 1987:1-18.

Shi H, Li JH, Ji CF, Shang HY, Qiu EC et al.[Effect of electroacupuncture on cortical spreading depression and plasma CGRP and substance P contents in migraine rats]. Zhen Ci Yan Jiu. 2010 Feb;35(1):17-21.

Son, C.G., 2009. Systemic review of RCTs focusing on chronic fatigue. The Journal of Korean Medicine, 30(6), pp.80-85.

Tang, L., Jiang, T., ZHu, F.Y., Liu, Z. and Wu, X., 2021. Acupuncture therapy on chronic fatigue syndrome based on radar plot: A protocol for an overview of systematic reviews. Medicine, 100(14).

Wang, J.J., Song, Y.J., Wu, Z.C., Chu, X.O., Wang, X.H., Wang, X.J., Wei, L.N. and Wang, Q.M., 2009. A meta analysis on randomized controlled trials of acupuncture treatment of chronic fatigue syndrome. Zhen ci yan jiu= Acupuncture Research, 34(6), pp.421-428.

Wang, T., Xu, C., Pan, K. and Xiong, H., 2017. Acupuncture and moxibustion for chronic fatigue syndrome in traditional Chinese medicine: a systematic review and meta-analysis. BMC complementary and alternative medicine, 17(1), pp.1-11.

Xue, K., Wang, Y., Wang, X., Chen, P., Xiao, C., Fu, J. and Cui, J., 2021. The efficacy and safety of moxibustion for chronic fatigue syndrome: A protocol for systematic review and meta-analysis. Medicine, 100(18).

Yin, Z.H., Wang, L.J., Cheng, Y., Chen, J., Hong, X.J., Zhao, L. and Liang, F.R., 2020. Acupuncture for chronic fatigue syndrome: an overview of systematic reviews. Chinese journal of integrative medicine, pp.1-7.

Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol. 2008 Aug;85(4):355-75.

Zhong G.-W. Li W. Effects of acupuncture on 5-hydroxytryptamine1F and inducible nitricoxide synthase gene expression in the brain of migraine rats. Journal of Clinical Rehabilitative Tissue Engineering Research. 2007;11(29)(pp 5761-5764)

Zijlstra FJ, van den Berg-de Lange I, Huygen FJ, Klein J. Anti-inflammatory actions of acupuncture. Mediators Inflamm. 2003 Apr;12(2):59-69.

Helen
Posted on: May-16-2016 8:16 am
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Acupuncture for Carpal Tunnel

Carpal Tunnel Syndrome – Condition Resources

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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.

CTS is a common condition (Atroshi et al, 1999), a type of compression neuropathy causing possible tingling, burning or dull sensations and symptoms in the hands. It is caused by the median nerve being compressed as is passes through the wrist(s). Common treatments include splinting, local steroid injections, painkillers, sometimes surgery is required.

A scholarly search of the available research papers on the terms “acupuncture” + “carpal tunnel” yields over 9,000 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives over 1000 results; of which over a third have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used traditionally and currently in this area, research has been carried out, the pace of which is increasing in recent years, and as such that it has been recognised its potential role is worthy of appraisal in a scientific manner.

Interpreting the research:

When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

Research and Resources on Carpal Tunnel Syndrome and Acupuncture:

A number of systematic reviews have been done in this area, including Badia and Santafé, 2020, a Spanish study examining 21 articles and concluding that “acupuncture and electroacupuncture are a therapeutic option for mild to moderate CTS with a medium level of scientific evidence, tending towards a high level, and with a medium level of recommendation.” Wu et al’s systematic review (2020) looked at 10 RCT studies in this area, drawing a similar conclusion for symptom relief. A Korean systematic review to examine reporting quality of 9 RCT’s in this area (Hyun et al, 2020) concurred with Badia and Santafé, that the evidence quality was moderate, and also concluded that traditional point PC7 was the most commonly employed in this area.

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”. 

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)

Acupuncture stimulates the body to create its own natural painkilling substances, such as Beta Endorphins (β-Endorphin). In studies acupuncture has been shown to stimulate the production of natural painkillers called opioid-like peptides (OLPs), including β-Endorphin: For example, this was shown in an RCT in 90 patients with a range of painful disorders (Petti et al, 1998). The same study showed acupuncture also and enhanced the activity of immune cells (lymphocytes, natural killer cells and monocytes) that help fight infections and diseases (Petti et al, 1998).

Other studies (Zijlstra et al, 2003) have revealed that acupuncture some of the pain modulating and anti-inflammatory effects exhibited in acupuncture 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.

Regarding Your Individual Condition and Symptoms:

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response.  We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation.  For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

Resources:

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

References:

Atroshi, I., Gummesson, C., Johnsson, R., Ornstein, E., Ranstam, J. and Rosen, I., 1999. Prevalence of carpal tunnel syndrome in a general population. Jama, 282(2), pp.153-158.

Badia, M. and Santafé, M.M., 2020. Acupuncture and electroacupuncture in the treatment of carpal tunnel syndrome: systematic review. Journal of Invasive Techniques in Physical Therapy Vol, 3(1).

Hyun, J.Y., Shin, J.E., Im, C.J. and Park, J.Y., 2020. A Systematic Review on the Reporting Quality of Acupuncture Treatment for Carpal Tunnel Syndrome. Korean Journal of Acupuncture, 37(3), pp.131-144.

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

Li, Y., Yu, Y., Liu, Y. and Yao, W., 2022. Mast cells and acupuncture analgesia. Cells, 11(5), p.860.

Petti, F.., Bangrazi, A., Liguori, A., Reale, G. and Ippoliti, F., 1998. Effects of acupuncture on immune response related to opioid-like peptides. Journal of Traditional Chinese Medicine 18(1), pp.55-63.

Wu, I.X., Lam, V.C., Ho, R.S., Cheung, W.K., Sit, R.W., Chou, L.W., Zhang, Y., Leung, T.H. and Chung, V.C., 2020. Acupuncture and related interventions for carpal tunnel syndrome: systematic review. Clinical rehabilitation, 34(1), pp.34-44.

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
Posted on: May-15-2016 13:52 pm
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Shaftesbury Clinic Star of Conditions

Bell’s Palsy – Condition Resources

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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.

Bell’s Palsy affects approximately 1 in 5,000 people per year in the UK; it is a condition whereby one side of facial muscles suddenly become weakened.

Research and Resources on Bell’s Palsy and Acupuncture:

A search on scientific papers for “acupuncture” + “Bell’s Palsy” reveals over 2000 results, of which 180 show up as “RCT”‘s* (see below), of these 51 have been carried out since 2017 . From this we can deduce that acupuncture is being used traditionally and currently in this area; that scientific researched is ongoing, with the pace of research increasing – indicating an area worthy of scientific appraisal and consideration.  

The British Acupuncture Council have produced an evidence-based factsheet on Bell’s Palsy and acupuncture research, including details of the research studies done (link below) and you can also find and read the original research from this resource.

Any research articles referred to on this page (and on the BAcC helpsheets) are listed in full in the References section at the foot of the relevant page.  Within the text, where studies are quoted as sources of the information being given, the first author’s name and the year of the paper is used (as authors usually have numerous publications), with the full title, journal, etc listed in the References section, in alphabetical order by Author surname to enable identifying and finding the original source paper.

About the research:

When reading health research, it is important to know that Systematic Reviews** or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study* (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

Regarding Your Individual Condition and Symptoms:

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response, we are able to tell you in the decades of experience we personally have at the clinic of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, which is why the research data do not tell the whole story and if you want to find out more specific information in how this could relate to your own individual situation, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

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

Helen
Posted on: May-15-2016 13:46 pm
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Acupuncture for Allergy and Hayfever

Allergic Rhinitis – Condition Resources

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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.

Allergic Rhinitis, also known as hayfever; affects 10-40% of people in the UK, and can be either seasonal or perennial.

A scholarly search of the available research studies on “acupuncture” + “allergic rhinitis” reveals over 6,900 papers from journals, and narrowing this to “RCT” leads to over 770 hits, of which 36% have been carried out since 2017.  From this we can deduce that acupuncture is used extensively, traditionally and currently in this area; and being researched at an increasing pace – leading us to understand this is an area worthy of scientific appraisal and consideration.

Interpreting the research:

When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

The Research:

The British Acupuncture Council has a Research digest where they examined some recent studies on Allergic Rhinitis, with an overall trend that acupuncture was found beneficial, comparing favourably with antihistamine use.  A review of the literature (Taw et al, 2015) found that high-quality RCTs demonstrated efficacy and effectiveness of acupuncture in this condition, and also was beneficial in terms of quality of life measures, the researchers also stated that further high quality studies are desirable in this area due to some methodological limits on study designs.  

Feng et al, (2015) carried out a systematic review and meta-analysis of acupuncture in allergic rhinitis, entailing 13 papers (N=2365 in total); the researchers stated this was a safe intervention which gave improvement in the Rhinitis Quality of Life Questionnaire (RQLQ) scores of the participants in the acupuncture groups.

According to a systematic review and meta-analysis by Yin et al (2020: 39 studies; n=4413) acupuncture can significantly improve the symptoms and quality of life of patients with allergic rhinitis. The authors searched various databases and included 30 randomized controlled trials with 4413 participants. They found that acupuncture improved the nasal symptoms and quality of life of patients with allergic rhinitis, compared to no intervention, sham acupuncture, or conventional medication. They also reported that acupuncture had a better safety profile than medication.

Two studies have also established cost effectiveness of acupuncture in this field Kim et al, (2012) carried out a systematic review of 17 RCTs using the quality-adjusted life years (QALYs) measure the NHS uses, demonstrating that as well as offering benefits, these were value for money where acupuncture was used.  Witt and Brinkhaus (2010) reached a similar conclusion but more tentatively, calling for further studies to establish this.

McDonald et al (2013) reviewed the pathophysiology of allergic rhinitis and the acupuncture research body in this area.  Acupuncture has been shown to improve clinical outcomes in patients with allergic rhinitis by modulating immune response and reducing inflammation.  Per the review of RCTs, acupuncture may down-regulate Th2 and proinflammatory cytokines, proinflammatory neuropeptides (such as SP, CGRP and VIP) and neurotrophins (such as NGF and BDNF) in allergic rhinitis. Acupuncture may also inhibit histamine-induced itch and TRPV1 signalling, which mediate some of the symptoms of allergic rhinitis.

Possible mechanisms of action in allergy:

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 exhibited in acupuncture 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. 

Acupuncture stimulates the body to create its own natural painkilling substances, such as Beta Endorphins (β-Endorphin). In studies acupuncture has been shown to stimulate the production of natural painkillers called opioid-like peptides (OLPs), including β-Endorphin: For example, this was shown in an RCT in 90 patients with a range of painful disorders (Petti et al, 1998). The same study showed acupuncture also and enhanced the activity of immune cells (lymphocytes, natural killer cells and monocytes) that help fight infections and diseases (Petti et al, 1998).

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)

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 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.

In an animal study, Sun et al, (2023) were able to show that electroacupuncture 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.

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.

Per MacDonald et al (2015), acupuncture may: reduce inflammation and nasal congestion by downregulating proinflammatory neuropeptides, cytokines, and neurotrophins; modulate immune function by altering the balance of Th1 and Th2 cells and suppressing mast cell degranulation; influence various receptors and signalling pathways that are involved in inflammatory response, such as TRPV1, opioid, chemokine, dopamine, and cannabinoid receptors; activate a novel cholinergic anti-inflammatory pathway that involves vagal and sciatic nerves and is mediated by dopamine.

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.

Regarding Your Individual Condition and Symptoms:

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response.  We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation. For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

Resources:

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

Our pages on Allergies may also be of interest

References:

Feng, S., Han, M., Fan, Y., Yang, G., Liao, Z., Liao, W. and Li, H., 2015. Acupuncture for the treatment of allergic rhinitis: a systematic review and meta-analysis. American journal of rhinology & allergy, 29(1), pp.57-62.

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.

Kim, S.Y., Lee, H., Chae, Y., Park, H.J. and Lee, H., 2012. A systematic review of cost-effectiveness analyses alongside randomised controlled trials of acupuncture. Acupuncture in Medicine, 30(4), pp.273-285.

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 Medicine, 8(1), pp.1-8.

Li, Y., Yu, Y., Liu, Y. and Yao, W., 2022. Mast cells and acupuncture analgesia. Cells, 11(5), p.860.

McDonald, J.L., Cripps, A.W., Smith, P.K., Smith, C.A., Xue, C.C. and Golianu, B., 2013. The anti-inflammatory effects of acupuncture and their relevance to allergic rhinitis: a narrative review and proposed model. Evidence-Based Complementary and Alternative Medicine, 2013.

Petti, F.., Bangrazi, A., Liguori, A., Reale, G. and Ippoliti, F., 1998. Effects of acupuncture on immune response related to opioid-like peptides. Journal of Traditional Chinese Medicine 18(1), pp.55-63.

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 Medicine, 2023

Taw, M.B., Reddy, W.D., Omole, F.S. and Seidman, M.D., 2015. Acupuncture and allergic rhinitis. Current opinion in otolaryngology & head and neck surgery, 23(3), pp.216-220.

Wang, M., Liu, W., Ge, J. and Liu, S., 2023. The immunomodulatory mechanisms for acupuncture practice. Frontiers in Immunology, 14.

Witt, C.M. and Brinkhaus, B., 2010. Efficacy, effectiveness and cost-effectiveness of acupuncture for allergic rhinitis—an overview about previous and ongoing studies. Autonomic Neuroscience, 157(1-2), pp.42-45.

Yin, Z., Geng, G., Xu, G., Zhao, L. and Liang, F., 2020. Acupuncture methods for allergic rhinitis: a systematic review and bayesian meta-analysis of randomized controlled trials. Chinese medicine, 15(1), pp.1-28.

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
Posted on: May-15-2016 11:44 am
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Acupuncture for Acne

Acne – Condition Resources

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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.

Approx. 15 in 1,000 people in UK suffer with acne, but for most, the exact cause is unknown.

Research and Resources on Acne and Acupuncture:

A scholarly search on “acne” + “acupuncture” reveals over 1,800 papers, and narrowing to Randomised Controlled Trials (RCT’s) reveals over 640 results (Google Scholar). This suggests that acupuncture is being used traditionally and currently in this area, and that it has been recognised there is a need to research it a scientific manner.

The British Acupuncture Council have produced an evidence-based factsheet on acne and acupuncture research, including details of the research studies done (link below) and you can also find and read the original research from this resource.

Any research articles referred to on this page (and on the BAcC helpsheets) are listed in full in the References section at the foot of the relevant page.  Within the text, where studies are quoted as sources of the information being given, the first author’s name and the year of the paper is used (as authors usually have numerous publications), with the full title, journal, etc listed in the References section, in alphabetical order by Author surname to enable identifying and finding the original source paper.

About the research:

When reading health research, it is important to know that Systematic Reviews** or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study* (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

Regarding Your Individual Condition and Symptoms:

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response, we are able to tell you in the decades of experience we personally have at the clinic of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, which is why the research data do not tell the whole story and if you want to find out more specific information in how this could relate to your own individual situation, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

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

Helen
Posted on: May-15-2016 10:03 am
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Is acupuncture just a placebo?

Blog, Research, Shaftesbury Clinic, , ,

We are always happy to answer any questions that people put to us about acupuncture. One of the ones that used to take me by surprise was “but it’s just a placebo, right?”
Really? What a question. I was surprised to consider it possible that anyone would believe that an entire profession, training colleges, regulatory boards and research bodies would be built on a treatment that was placebo. Where would the ethics and justification come from? Why would acupuncture still exist?
Read More Is acupuncture just a placebo? →

Helen
Posted on: Apr-5-2016 10:32 am
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Shaftesbury Clinic Star of Conditions

Visual Disorders – Condition Resources

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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.

References:

Helen
Posted on: Mar-16-2016 14:30 pm
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Acupuncture for Tennis and Golfer's Elbow

Tennis & Golfers Elbow – Condition Resources

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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.

Chronic Pain in General

“Acupuncture is effective for the treatment of chronic musculoskeletal, headache, and osteoarthritis pain. Treatment effects of acupuncture persist over time and cannot be explained solely in terms of placebo effects. Referral for a course of acupuncture treatment is a reasonable option for a patient with chronic pain”. (Vickers et al, 2018: large chronic pain review of high quality RCTs updating a previous meta-analysis; 39 trials, n=20827; conditions addressed chronic headache, back/neck pain and osteoarthritis)

Another recent overview (Yin et al, 2017) confirms that there is increasing evidence for acupuncture  as an effective, safe, and cost-effective intervention in chronic low back, neck, shoulder, and knee pain, as well as headaches.

The NHS body in charge of which treatments should be used in particular conditions recommends acupuncture for chronic pain:  The NICE Scenario Management guidelines (2021) for chronic pain state: “consider a course of acupuncture or dry needling, within a traditional Chinese or Western acupuncture system”

Overall, a large systematic review has found acupuncture a cost effective intervention for several painful conditions (Ambrósio et al, 2012).

Tennis Elbow

The British Acupuncture Council has a Research digest where they examined some recent studies on lateral elbow pain, as well as an evidence based factsheet (tennis elbow – links are below), finding promising evidence in the field.   

Gadau et al, (2014) conducted a systematic review of 19 RCTs of varying quality were examined, and overall the evidence suggested acupuncture was more effective than sham control.  Tang et al (2015) looed at a smaller number of RCT and were more tentative about the outcomes due to concern over trial designs and highlighted a need for further research.

Recent small trials include one comparing acupuncture and manipulation (n=35; Hsu et al, 2016) in which both groups experienced improvement in pain and function.  Another looked at ultrasound imaging of the affected tendon to evaluate acupuncture’s effect, finding reduction of tendon thickness after 10 sessions as well as improvement in pain scores (Ural et al 2017; n-41).  A further trial (Wong  et al, 2017; n=34) compared acupuncture and extracorporeal shockwave therapy (ESWT), finding a trend of improvement in pain scores in both groups.

Mechanisms of Action

Acupuncture stimulates the body to create its own natural painkilling substances, such as Beta Endorphins (β-Endorphin). In studies acupuncture has been shown to stimulate the production of natural painkillers called opioid-like peptides (OLPs), including β-Endorphin: For example, this was shown in an RCT in 90 patients with a range of painful disorders (Petti et al, 1998). The same study showed acupuncture also and enhanced the activity of immune cells (lymphocytes, natural killer cells and monocytes) that help fight infections and diseases (Petti et al, 1998).

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 (BAcC) evidence based factsheet about Tennis and Golfers Elbow including specific research, trials and mechanisms of action for acupuncture in this condition.

BAcC Sports Injuries Factsheet

BAcC Research Digest

References:

General Chronic Pain References:

Ambrósio, E.M.M., Bloor, K. and MacPherson, H., 2012. Costs and consequences of acupuncture as a treatment for chronic pain: a systematic review of economic evaluations conducted alongside randomised controlled trials. Complementary therapies in medicine, 20(5), pp.364-374.

Vickers, A.J., Vertosick, E.A., Lewith, G., MacPherson, H., Foster, N.E., Sherman, K.J., Irnich, D., Witt, C.M., Linde, K. and Acupuncture Trialists’ Collaboration, 2018. Acupuncture for chronic pain: update of an individual patient data meta-analysis. The Journal of Pain, 19(5), pp.455-474.

Birch, S., Lee, M.S., Alraek, T. and Kim, T.H., 2018. Overview of treatment guidelines and clinical practical guidelines that recommend the use of acupuncture: a bibliometric analysis. The Journal of Alternative and Complementary Medicine, 24(8), pp.752-769.

NICE 2021 Chronic pain: Scenario: Management Last revised in April 2021

Petti, F.., Bangrazi, A., Liguori, A., Reale, G. and Ippoliti, F., 1998. Effects of acupuncture on immune response related to opioid-like peptides. Journal of Traditional Chinese Medicine 18(1), pp.55-63.

Yin, C., Buchheit, T.E. and Park, J.J., 2017. Acupuncture for chronic pain: an update and critical overview. Current opinion in anaesthesiology, 30(5), pp.583-592.

Tennis Elbow References:

Gadau, M., Yeung, W.F., Liu, H., Zaslawski, C., Tan, Y.S., Wang, F.C., Bangrazi, S., Chung, K.F., Bian, Z.X. and Zhang, S.P., 2014. Acupuncture and moxibustion for lateral elbow pain: a systematic review of randomized controlled trials. BMC Complementary and Alternative Medicine, 14(1), pp.1-19.

Tang, H., Fan, H., Chen, J., Yang, M., Yi, X., Dai, G., Chen, J., Tang, L., Rong, H., Wu, J. and Liang, F., 2015. Acupuncture for lateral epicondylitis: a systematic review. Evidence-based complementary and alternative medicine, 2015.

Hsu, C.Y., Lee, K.H., Huang, H.C., Chang, Z.Y., Chen, H.Y. and Yang, T.H., 2016. Manipulation therapy relieved pain more rapidly than acupuncture among lateral epicondylalgia (tennis elbow) patients: a randomized controlled trial with 8-week follow-up. Evidence-Based Complementary and Alternative Medicine, 2016.

Ural, F.G., Öztürk, G.T., Bölük, H. and Akkuş, S., 2017. Ultrasonographic evaluation of acupuncture effect on common extensor tendon thickness in patients with lateral epicondylitis: a randomized controlled study. The Journal of Alternative and Complementary Medicine, 23(10), pp.819-822.

Wong, C.W.Y., Ng, E.Y.L., Fung, P.W., Mok, K.M., Yung, P.S.H. and Chan, K.M., 2017. Comparison of treatment effects on lateral epicondylitis between acupuncture and extracorporeal shockwave therapy. Asia-Pacific journal of sports medicine, arthroscopy, rehabilitation and technology, 7, pp.21-26.

Helen
Posted on: Feb-19-2016 14:22 pm
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