Acupuncture is a complementary approach that originated from traditional Chinese medicine, from a theory that the flow of vital energy, or “Qi” (pronounced CHEE, I believe, unless someone who speaks Chinese tells me otherwise) can be regulated by stimulation of key body areas with needles, heat, or pressure. It is generally felt to be quite safe when performed by properly qualified individuals, although caution is appropriate for patients with a tendency toward increased bleeding or known low platelets. Acupuncture has been the subject of a reasonable amount of study, and it appears that there are significant physiologic effects of acupuncture, mediated through effects on the nervous system. Specifically, studies show effects in terms of changes during acupuncture in release of proteins in the brain, called neurotransmitters, as well as neuro-imaging like functional MRI. While it has historically been utilized for a very wide range of medical problems, the value of acupuncture in evidence-based medicine appears to be considerably more limited, but definitely relevant for a few common issues facing patients with cancer.
It is currently strongly recommended in the recent ACCP guidelines (abstract here) as an additional therapy for pain control among patients who don’t have good pain control, who have side effects from other treatments (such as the well-known constipation, nausea, somnolence, and mental status changes that can accompany otherwise very helpful narcotics), or who are trying to cut down on pain medications. Pain is the most common use and the setting in which acupuncture has been best studied. It’s been shown to be beneficial in treating both acute pain such as following surgery, as well as chronic pain such as headaches (abstracts here and here). One trial (abstract here) that randomized 570 patients with arthritic knee pain significantly demonstrated significant improvement among those who underwent a 26-week course of acupuncture compared with those who underwent sham acupuncture (conducted in a way outside of the proper principles but otherwise technically similar). All of these patients received other standard care for osteoarthritis, but eight weeks into the program, both pain and knee function were significantly better among those who received acupuncture according to proper techniques. A similar study (actually a companion article in the same issue of the same journal; abstract here) in chronic neck pain showed that acupuncture also improved survival in this setting. However, a recent meta-analysis indicated that acupuncture hasn’t been significantly beneficial for low back pain beyond other standard therapies (abstract here).
Fortunately, the available evidence indicates that acupuncture can be effective against cancer-related pain. One study of acupuncture against a placebo, sham acupuncture procedure tested acupuncture around the ear for patients who continued to have pain despite being on a stable pain regimen (abstract here). This wasn’t a large trial, including just 90 patients, but those who had needles placed at the supposedly effective acupuncture points had a decrease in pain intensity by 36% by two months into treatment; in the patients who did not receive acupuncture to presumed appropriate acupuncture points, there was little to no change in pain levels. What was also particularly impressive in this small study was that most of the patients had a type of pain called neuropathic pain that is generally regarded as particularly challenging to treat effectively. Studies of brain imaging show changes in certain key areas of brain activity that are seen with the “proper” form of acupuncture but not with control/placebo stimulations that are done at presumed ineffective points of stimulation (abstract here).
Currently, acupuncture is also being studied for “post-thoracotomy syndrome”, the chronic pain that can result from cut nerves after open lung surgery; we don’t have results yet on its value in this setting.
Next, I’ll turn to the use of acupuncture for settings other than pain control.
posted by Dr. West @ 12:31 am link to this post
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November 24th, 2007 at 8:58 am
Sorry Dr. West,
It’s hard for me to have an open mind about these alternative treatment (specifically this treatment modality)with such low study enrollments and very large dropout rates.
In one of the studies mentioned above, it’s limitations were:
Limitations: At 26 weeks, 43% of the participants in the education group and 25% in each of the true and sham acupuncture groups were not available for analysis”
A lot of people dropped out of the study for some reason, and readers should know that.
Would such low study enrollments, and such a large dropout rate hold water with oncologists for a new cancer drug treatment with similiar results by big pharma? Why was there no mention about the number of patients who quit smoking or lost weight? Acupuncture seems to be a treatment often used to help these people too.
If I go back to my father once again, do you know how many times that he said that his pain was NOT between an 8 to 10 when asked by his nurses during his almost 7 month hospital stay? In some cases he was almost “snowed” over in morpine and methadone and would still say he was at an 8 for pain.
The point being, pain is a very very difficult thing to test and measure as it is, doctors cannot “see” pain. And sometimes people’s pain just starts to get better on it’s own for no reason.
What enrollment sizes were the studies that aspirin, acetametaphine, naproxen, celebrex, vioxx, etc. undergo before they were considered for approval by the FDA? Let’s wait for similiarly sized studies before we take this stuff seriously.
Meanwhile, my health insurance provider now covers periodic “back massages” by a chiropractor if prescribed by a doctor for a medical condition. However, almost 200,000 will die this year from lung caner and still no insurance coverage for any sort of diagnostics for this terrible disease.
Jim
November 24th, 2007 at 5:36 pm
Your points are very well taken, Jim. I am still reading about the subject, which really isn’t taught or covered in conventional medical training or oncology fellowship programs, and it’s absolutely true that there are serious methodologic flaws. However, how stringent I am depends on the downside: acupuncture isn’t a $10,000 per month intervention, like some of our newer targeted therapies, it’s got very little risk of real adverse effects, and it doesn’t need to replace any other things we do. So I think it’s appropriate to be skeptical, but I assure you that there’s no group trying to decide whether to back acupuncture or lung cancer screening. If I had to choose between funding chemo, or narcotics, and acupuncture, I’d go with the far more established conventional approaches, but I think that even if acupuncture adds little, even a marginal or unclear benefit can exceed a very minimal risk.
-Dr. West
December 11th, 2007 at 6:36 pm
Hi guys. Several years ago I suffered from hip pain as well as breathing problems (I have lung cancer now) I was diagnosed with emphysma in 1999and took some acupuncture treatments at that time and they helped a great deal. The problem for me is I also took some Chinese herbs. so, who knows which helped. I do know that Acupuncture does lower blood pressure and there are studies that confirm that. I intend to try acupuncture to boost my immune system. Will let you know how it goes. I am fighting this cancer with all I have…thank you Dr. West for going on this journey with me.
December 15th, 2007 at 7:08 pm
I can assure the acupuncture is one of the best complimentary and sometimes alternative modalities out there. Not only can it releive pain but at the very least promote a sense of well being relieving anxiety. Most of the world has know this for thousands of years. My mother had some wonderful experiences on the acupucture table to which I am grateful. Most of all it is non toxic and and has no side effects—-at the least it is worth a shot. The needles are as thin as hair and are not deep into the skin –really the are barely there and you rarely feel them. Some insurance companies are now giving 6 sessions if recommened by a doctor. However ask around and I am sure you find someone who knows an acupucturist with a good rep. I love mine.