Who is recommending Acupuncture?

 

Acupuncture sure has it’s fair share of skeptics, despite gaining in popularity. But who exactly is recommending patients to acupuncture these days?

In 2007, a joint clinical practice guideline from the American College of Physicians and the American Pain Society was published. They certainly leave Acupuncture as a last resort, but end up saying:

For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits-for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence).

In 2009, the Royal College of General Practitioners (UK) issued a report on the Early Management of Persistent Non-specific Low Back Pain in which they stated:

Consider offering a course of acupuncture needling comprising up to a maximum of 10 sessions over a period of up to 12 weeks.

The World Health Organization (WHO) has released a list of conditions it feels there is adequate evidence for acupuncture to be effective in it’s review and analysis. Since there are too many to list, I will just highlight a few.

Diseases, symptoms or conditions for which acupuncture has been proved— through controlled trials—to be an effective treatment:

• Allergic rhinitis
• Headache
• Knee pain
• Low back pain
• Depression
• Morning sickness
• Nausea and vomiting
• Sprain
• Stroke
• Sciatica

According to the Mayo Clinic‘s page on Acupuncture.

Since acupuncture has few side effects, it may be worth a try if you’re having trouble controlling pain with more-conventional methods.

The National Cancer Institute has done it’s own review on Acupuncture for cancer related side effects pointing out results of several studies it had reviewed.

• The strongest evidence of the effect of acupuncture has come from clinical trials on the use of acupuncture to relieve nausea and vomiting. Several types of clinical trials using different acupuncture methods showed acupuncture reduced nausea and vomiting caused by chemotherapy, surgery, and morning sickness. It appears to be more effective in preventing vomiting than in reducing nausea.
• Randomized studies of patients with cancer-related fatigue found that those who had a series of acupuncture treatments had less fatigue compared to those who had acupressure, sham acupressure, or information about managing fatigue.
• Two studies compared acupuncture with standard care for preventing xerostomia (dry mouth)  in patients being treated with radiation therapy. The studies found that patients treated with acupuncture had fewer symptoms and increased saliva flow.
• The aim of most acupuncture clinical observation and clinical trials in cancer patients has been to study the effects of acupuncture on cancer symptoms and side effects caused by cancer treatment, including weight loss, cough, coughing up blood, anxiety, depression, proctitis, speech problems, blocked esophagus, hiccups, and fluid in the arms or legs. Studies have shown that, for many patients, treatment with acupuncture either relieves symptoms or keeps them from getting worse.

In 1994, 1,466 Norwegian physicians were surveyed on their attitudes to acupuncture and experience as acupuncture patients.

More than 8% had undergone acupuncture treatment and 38% of these reported benefit from the treatment. Over 53% would realistically consider acupuncture if they got problems or diseases where acupuncture treatment could be an alternative. More than 38% recommend acupuncture treatment to their migraine patients. More than four out of five doctors would not try to interfere with a patient’s wish to try acupuncture treatment for cancer. 81% said that acupuncture is, or should be integrated in the national health care system. More general practitioners held this view than other doctors. Positive attitudes were strongest among doctors who either had already undergone acupuncture treatment or intended to do so

In 1999 and 2005, the attitudes of Japanese medical doctors toward complementary and alternative medicine were surveyed.

The results showed that almost all doctors believed in the effectiveness of…acupuncture (88% and 82%, resp.) in 1999 and 2005.

In 2000, the British Medical Association released a publication titled Acupuncture Efficacy, safety and practice that included a survery among British GPs on their recommendation of Acupuncture.

• 47% of Britain’s GPs arranged acupuncture treatment for their patients last year (1999)
• Among GPs arranging acupuncture for their patients, 15% provided it themselves, 57% used another doctor, 24% a physiotherapist and only 5% a traditional Chinese medicine practitioner.
• Among all GPs, 79% wanted to see acupuncture available on the NHS and nearly half wanted training so that they could use this method for treating patients in future.

In a 1997 paper evaluating the use of Acupuncture among US physicians the authors concluded:

Physicians surveyed in this study who incorporate acupuncture into their practice do so mainly to treat pain problems. They are more likely to be in the 35 to 54 age group, nonspecialists, and in private practice when compared with national averages

In a 2005 paper published on use of acupuncture among physicians and non-physicians in the US, it had reported that:

• …up to a third of the 10,000 acupuncturists in the United States are medical doctors
• Despite this apparent difference in their predominant styles of acupuncture, there was a high correlation between physician and nonphysician licensed acupuncturist acupoint selection to treat low back pain

And in a 2010 paper on a survey of selected physician views on acupuncture in pain management in the US.

• We divided our 16 survey questions into five categories: 1) physician’s attitude toward acupuncture as a modality of pain management; 2) physician’s preference or belief with regard to the type of pain condition suitable for acupuncture referrals; 3) timing for making acupuncture referrals (e.g., acupuncture as a first line pain treatment option or a last approach after failed conventional pain management); 4) clinical assessment criteria for the effectiveness of acupuncture therapy; and 5) barriers to making acupuncture referrals
• The results indicate that an overwhelming majority of survey responders have a positive attitude and favorable experience with using acupuncture as an alternative modality for chronic pain management. However, our survey responders are mostly from teaching hospitals, suggesting a possible gap between teaching hospitals and other medical facilities (private practice and community hospitals) in utilizing acupuncture for pain management. The lack of insurance coverage and facility for acupuncture treatment are two primary barriers to making acupuncture referrals.
• The survey results indicate that acupuncture is considered by many physicians to be a useful alternative modality for chronic pain management.

And in the United States, Canada, Germany and other European countries, Medical Acupuncture has become increasingly popular among physicians, which is a style of acupuncture that doesn’t rely on the theory of qi and meridians, but rather an anatomical and neurological model. In some countries they have formed associations that only allows physicians to join.

• American Academy of Medical Acupuncture
• British Medical Acupuncture Society
• Australian Medical Acupuncture College

In Germany, where Acupuncture is the most popular alternative treatment,  along with France, Austria and Greece you need to be a medical doctor to perform acupuncture.

Finally, in countries like Canada, United States and Australia where non-physician practitioners can practice forms of needling, there are practitioners ranging from chiropractors, massage therapists, naturopathic doctors, and physiotherapists who are now adding a variation of acupuncture called dry needling to their scope of practice, which is essentially the same as medical acupuncture used for deactivating trigger points and relieving myofascial pain. It seems like everyone is jumping on board the bandwagon of using needles.

CONCLUSION: Yes, acupuncture does have it’s critics, but they are among the same people that are recommending for the use of acupuncture for certain conditions, as well as receiving training and offering those treatments themselves for certain conditions. The most outspoken critics of acupuncture are medical doctors, but some of the biggest supporters of acupuncture are medical doctors as well. It does appear that some physicians are more interested in getting their patients well, rather than worrying about how their patients are getting well.

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