It’s Official: Acupuncture Doctor Approved

The American College of Physicians formally recommends acupuncture for the treatment of back pain. Published in the prestigious Annals of Internal Medicine, clinical guidelines were developed by the American College of Physicians (ACP) to present recommendations based on evidence. Citing quality evidence in modern research, the ACP notes that nonpharmacologic treatment with acupuncture for the treatment of chronic low back pain is recommended. The official grade by the ACP is a “strong recommendation.” [1]

A major goal of the recommendation is for acupuncture and other nonpharmacological therapies to replace drug therapy as a primary source of pain relief. Treatment with opioids is only recommended, with an official “weak recommendation,” when other modalities do not provide adequate relief. A strong recommendation is also made by the American College of Physicians for the treatment of both acute and subacute lower back pain with heat, massage, acupuncture, and spinal manipulation. [2] The recommendations were approved by the ACP Board of Regents and involves evidence based recommendations from doctors at the Penn Health System (Philadelphia, Pennsylvania), Minneapolis Veterans Affairs Medical Center (Minnesota), and the Yale School of Medicine (New Haven, Connecticut). 

The American College of Physicians notes that approximately 25% of USA adults have had, at the very minimum, a one day lower back pain episode within the past three months. The socioeconomic impact of lower back pain in the USA was approximately $100 billion in the year 2006 . The costs include medical care and indirect costs due to lost wages and declines in productivity. [3] Recommendations for treatment options, including those for the use of acupuncture, include considerations of positive medical patient outcomes, the total number of back pain episodes, duration between episodes, alleviation of lower back pain, improvement in function of the back, and work disability reductions. Recommendations are for both radicular and nonradicular lower back pain.

The target audience for the American College of Physicians recommendations includes all doctors, other clinicians, and the adult population with lower back pain. The ACP notes, “Moderate-quality evidence showed that acupuncture was associated with moderately lower pain intensity and improved function compared with no acupuncture at the end of treatment .” [4] In agreement, the National Institute of Neurological Disorders and Stroke (National Institutes of Health) notes that acupuncture is an effective treatment modality for the relief of chronic lower back pain. [5]

These findings are consistent with those published in Mayo Clinic proceedings finding that acupuncture is effective for the treatment of lower back pain. The same Mayo Clinic report notes that acupuncture does not cause any significant adverse effects. [6] The Mayo Clinic findings apply to both nociceptive and non-nociceptive pain. Nociceptive back pain includes musculoskeletal inflammation and pain involving nerve cells wherein nociceptors are activated. Nociceptors are afferent neurons in the skin, muscles, joints, and other areas. For example, nerve impingement (often referred to as a “pinched nerve”) produces one type of nociceptive pain.

Non-nociceptive pain does not involve inflammation and is more relevant to pain processing in the central nervous system. One type of non-nociceptive pain condition is fibromyalgia and acupuncture has been confirmed as an effective treatment modality for this condition. The Mayo Clinic proceedings note, “Martin et al. found a significant improvement between electroacupuncture vs sham electroacupuncture. Differences were seen on the Fibromyalgia Impact Questionnaire (FIQ) scores for fatigue and anxiety.” [7]

Learn more about how to alleviate fibromyalgia related pain in the acupuncture continuing education course entitled Fibromyalgia Syndrome Treatments. Click the following to learn more:

Fibromyalgia Online Course >
 

The Mayo Clinic and American College of Physicians findings are consistent with additional quality research. Memorial Sloan Kettering Cancer Center (New York) and University of York (United Kingdom) researchers note “We have provided the most robust evidence from high-quality trials on acupuncture for chronic pain. The synthesis of high-quality IPD found that acupuncture was more effective than both usual care and sham acupuncture. Acupuncture is one of the more clinically effective physical therapies for osteoarthritis and is also cost-effective if only high-quality trials are analysed.” [8]

Doctors understand the true need for effective pain management. Nonpharmacological solutions are important for a variety of reasons including prevention of addiction, effective relief of pain, and prevention of adverse effects. This is often of heightened concern during pregnancy and for children. As a result, university hospitals integrate acupuncture into usual care settings to improve patient outcomes. For example, pediatric doctors at the UCSF Benioff Children’s Hospital San Francisco provide acupuncture to children, including non-needle laser acupuncture. At the University of California hospital, acupuncture is made available for both inpatients and outpatients. Dr. Kim notes that acupuncture reduces nausea up to 70%. She adds that acupuncture is also effective for significant reductions in post-surgical pain and chronic headaches. [9]

Recently, researchers have discovered how acupuncture stops pain and provides other forms of relief for patients. Breakthrough research conducted by University of South Florida (Tampa) and Fujian University of Traditional Chinese Medicine (Fuzhou) researchers documents how acupuncture stops pain. The researchers note, “acupuncture exerts a remarkable analgesic effect on SCI [spinal cord injury] by also inhibiting production of microglial cells through attenuation of p38MAPK and ERK activation.” [10]

Microglia are central nervous system immunity cells that secrete proinflammatory and neurotoxic mediators. Acupuncture reduces pain by attenuating this response. The researchers also document that acupuncture provides neuroprotection. The researchers note that acupuncture prevents brain damage in the hippocampus by “preventing microglial activation.” The University of South Florida members of the research team were from the Department of Neurosurgery and Brain Repair and the Department of Pharmaceutical Sciences. Funding was provided by the United States Department of Defense, University of South Florida Neurosurgery and Brain Repair, and the James and Esther King Biomedical Research Foundation.

The aforementioned research reveals an important biochemical mechanism involved in acupuncture’s ability to alleviate pain and reduce harmful inflammation. Researchers focus on other mechanisms activated by administration of acupuncture treatments. For example, laboratory investigations reveal how acupuncture regulates blood pressure.

University of California (Irvine) researchers find acupuncture effective for the treatment of high blood pressure. In a controlled laboratory study, University of California researchers have proven that electroacupuncture at acupoint ST36 (Zusanli) promotes enkephalin production, which dampens proinflammatory excitatory responses from the sympathetic nervous system that cause hypertension. Specifically, electroacupuncture regulates preproenkephalin gene expression, a precursor substance that encodes proenkephalin, which then stimulates the production of enkephalin. [11]

The formal recommendation for the use of acupuncture in cases of lower back pain by the American College of Physicians is based on modern research. Mayo Clinic findings and research from the Memorial Sloan Kettering Cancer Center (New York) and the University of York support this recommendation. In response to the needs of patients, doctors have already implemented acupuncture into several hospitals throughout the USA and both inpatient and outpatient acupuncture treatments are available.

Now, modern scientific investigations reveal how acupuncture works. University of South Florida and Fujian University of Traditional Chinese Medicine researchers confirm acupuncture’s ability to attenuate microglial activation. University of California researchers have quantified acupuncture’s ability to control inflammation by regulating enkephalins. In addition, the NCCAOM (National Certification Commission for Acupuncture and Oriental Medicine) provides professional certification for acupuncturists, which ensures standards of excellence for licensed acupuncturists. Given the large body of supportive research and the administrative support for providing safe and effective acupuncture to the general public, expect to see greater implementation of acupuncture into usual care settings.

Accessibility to care is dependent upon both availability and financial capabilities. Insurance companies have been providing health insurance coverage for acupuncture for decades. Cigna, Blue Cross, Blue Shield, AETNA, United Healthcare, and many other insurance companies provide reimbursement to patients for use of services by licensed acupuncturists. The level of coverage varies, largely dependent upon individual health insurance policy provisions. Licensed acupuncturists can learn more about providing coverage for their patients in the continuing education course entitled Acupuncture Insurance Billing #1. This basic introductory course covers diagnostic requirements, including ICD-10 coding, and other important procedural requirements necessary to obtain reimbursements for patient care.
 

References
1. Qaseem, Amir, Timothy J. Wilt, Robert M. McLean, and Mary Ann Forciea. "Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of PhysiciansNoninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain." Annals of Internal Medicine (2017).
2. Qaseem, et al. Annals of Internal Medicine (2017).

3. Katz J.N. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences.J Bone Joint Surg Am200688 Suppl 2214.
4. Lam M. Galvin R. Curry P. Effectiveness of acupuncture for nonspecific chronic low back pain: a systematic review and meta-analysis.Spine (Philadelphia, Pennsylvania 1976) 201338212438.
5. ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet. Low Back Pain Fact Sheet, National Institute of Neurological Disorders and Stroke, National Institutes of Health.
6. Nahin, Richard L., Robin Boineau, Partap S. Khalsa, Barbara J. Stussman, and Wendy J. Weber. "Evidence-based evaluation of complementary health approaches for pain management in the United States." In Mayo Clinic Proceedings, vol. 91, no. 9, pp. 1292-1306. Elsevier, 2016.
7. Martin DP, Sletten CD, Williams BA, Berger IH. Improvement
in fibromyalgia symptoms with acupuncture: results of a randomized
controlled trial. Mayo Clin Proc. 2006;81(6):749-757.
8. MacPherson, H., A. Vickers, M. Bland, D. Torgerson, M. Corbett, E. Spackman, P. Saramago et al. "Acupuncture for chronic pain and depression in primary care: a programme of research." (2017).

9. Leslie Lingaas. ucsf.edu/news/2014/04/113966/acupuncture-helps-young-patients-manage-pain. Acupuncture Helps Pediatric Patients Manage Pain and Nausea, 2014.
10. Lin, Lili, Nikola Skakavac, Xiaoyang Lin, Dong Lin, Mia C. Borlongan, Cesar V. Borlongan, and Chuanhai Cao. "Acupuncture-induced analgesia: the role of microglial inhibition." Cell transplantation 25, no. 4 (2016): 621-628.
11. Cevic, C and Iseri, SO. The effect of acupuncture on high blood pressure of patients using antihypertensive drugs. Acupuncture & electro-therapeutics research 2013; 38(1-2): 1-15. ncbi.nlm.nih.gov/pubmed/23724695.

This article originally appeared on http://www.healthcmi.com

Here's What Just 3 Weeks Of Acupuncture Did For My Digestion, Sleep & Energy Levels

Acupuncture always seemed like a voodoo-type practice to me, so I never considered it an option. However, I recently experienced about two months of consistent bloating to the point that I looked three months pregnant in a swimsuit. I tweaked my diet, cut out coffee, started meditating more, but still the bloating remained. So, I decided to finally give acupuncture a try. What could happen? After all, I have been battling ulcerative colitis for nine years now and have become open to just about anything that will alleviate my symptoms.

I saw an acupuncturist twice a week for one month. He applied traditional acupuncture techniques while incorporating craniosacral work. Here's what happened:

Week 1:

After my first week of treatment, my bloating decreased significantly to where I no longer felt discomfort. Unexpectedly, I also noticed fewer chronic fatigue symptoms. I often get body aches but those were gone and I felt like I had quite a bit more energy.

Week 2:

I told the acupuncturist that I was having a hard time sleeping so he adjusted his needle points accordingly and began performing craniosacral work on my head and neck. Without realizing it, I fell asleep on the table almost immediately and had the most restful sleep I'd had in a while. Even more, I've been able to sleep well and wake up feeling rested ever since this treatment.

In addition, I usually know when my period is about to start by the severe back pain and discomfort in the day and hours leading up to it. The first day of my period is always the worst—and I mean the absolute worst. Painful cramps normally plague me on the first and second day. This time around? I had NONE—I couldn't believe it. The second day showed very slight discomfort but was the easiest period I’ve had in a long time. To me, this meant that the acupuncture was lowering my inflammation levels and helping ease my hormonal changes throughout the month.

Week 3:

I didn’t fall asleep this time, but that is likely because I was already getting great sleep at night and was feeling very alert. I mentioned to the acupuncturist that I was having exams in grad school and that I was stressed about them. Again, he adjusted the location of the needles and let me rest on the table, listening to Bob Marley. Maybe it was the needles, maybe it was Bob—or probably a combination of the two—but I felt like I had just had a massage as I walked out of the office. I also started feeling more alert and energized during the day, without the help of coffee, and was able to focus in classes better than before.

The take-home message? Acupuncture is the bee’s knees! I am officially a skeptic turned believer in just three short weeks. Will the effects keep on lasting? It's hard to say, but so far so good. My health condition is not an easy one to manage, so knowing that this is a viable option for me to help keep my symptoms at bay is absolutely priceless.

This article originally appeared on MindBodyGreen & was written by Holly Campbell.

Acupuncture - The Oldest Health Care System in the World

The origins of acupuncture in China can be traced back at least 2000 years, making it one of the oldest and most long-standing health care systems in the world. Today, acupuncture is an effective, natural and increasingly popular form of health care that is being used by people from a wide range of cultural and social backgrounds.

Acupuncture is a time-honoured medicine and takes a holistic approach to understanding normal function and disease processes and focuses as much on the prevention of illness as on the treatment.

What is qi & how does it affect the body?
When healthy, an abundant supply of qi (pronounced chee) or "life energy" flows through the body's meridians (a network of invisible channels through the body). If the flow of qi in the meridians becomes blocked or there is an inadequate supply of qi, then the body fails to maintain harmony, balance and order, and disease or illness follows. This can result from stress, overwork, poor diet, disease pathogens, weather and environmental conditions, and other lifestyle factors and becomes evident to TCM practitioners through observable signs of bodily dysfunction. TCM practitioners look carefully for these signs of health and dysfunction, paying particular attention not only to the presenting signs and symptoms, but also to the medical history, general constitution, and the pulse and tongue.

How does acupuncture work?
Acupuncture treatment involves the insertion of fine, sterile needles into specific sites (acupuncture points) along the body's meridians to clear energy blockages and encourage the normal flow of qi through the individual. The practitioner may also stimulate the acupuncture points using other methods, including moxibustion, cupping, laser therapy, electro-stimulation and massage, in order to re-establish the flow of qi.

As a natural form of healing, acupuncture has the following benefits:

• provides drug-free pain relief
• effectively treats a wide range of acute and chronic ailments
• treats the underlying cause of disease and illness as well as the symptoms
• provides an holistic approach to the treatment of disease and illness, linking body, mind and emotions
• assists in the prevention against disease and illness as well as the maintenance of general well-being

Acupuncture is known to treat a wide range of disorders including:

• Neurological conditions such as headaches, migraines, difficulty sleeping, nervous tension, stroke, some forms of deafness, facial and inter-costal neuralgia, trigeminal neuralgia, some forms of paralysis, sequelae of poliomyelitis, peripheral neuropathy, noises in the ears, dizziness, and Meniere's disease.
   
• Cardiovascular disorders such as high or low blood pressure, fluid retention, chest pain, angina pectoris, poor circulation, cold hands and feet, and muscle cramps.
   
• Respiratory conditions such as bronchial asthma, acute and chronic bronchitis, acute tonsillitis, rhinitis, sinusitis, hay fever, chronic cough, laryngitis, sore throat, influenza and the common cold.
   
• Digestive system disorders such as toothache, post-extraction pain, gingivitis, mouth ulcers, hiccough, spasms of the oesophagus, gastric and duodenal ulcers, gastric hyperacidity, gastritis, heartburn, hiatus hernia syndrome, flatulence, paralytic ileus, colitis, diarrhoea, constipation, haemorrhoids, liver and gall bladder disorders, and weight control.
   
• Urogenital disorders such as cystitis, prostatitis, orchitis, low sexual vitality, urinary retention, kidney disorders, nocturnal enuresis, and neurogenic bladder dysfunction.
   
• Gynaecological and obstetric disorders such as premenstrual tension, painful, heavy or irregular, or the absence of periods, abnormal uterine bleeding or discharge, hormonal disturbances, disorders associated with menopause, prolapse of the uterus or bladder, difficulty with conception, and morning sickness.mu
   
• Skin conditions such as eczema, dermatitis, psoriasis, nerve rash, herpes zoster, acne, scar tissue and resultant adhesions, hair loss and dandruff.
   
• Eye conditions such as visual disorders, red, sore, itchy or watery eyes, conjunctivitis, simple cataracts, myopia in children, and central retinitis.
   
• Musculoskeletal disorders such as osteoarthritis, sciatica, lumbago, weak back, low back pain, rheumatoid arthritis, gout, tenosynovitis, shoulder and neck pain, cervicobrachial syndrome, 'frozen shoulder', and 'tennis elbow'.
   
• Sporting injuries such as sprained ankles and knees, cartilage problems, corking and tearing of muscles, torn ligaments and bruises.
   
• Psychological conditions such as depression, phobias, emotional disturbances, anxiety, nervousness and addictions such as smoking.

* The disorders above which appear in bold have been recognised by the World Health Organisation (December 1979) as having been successfully treated by acupuncture. The disorders which do not appear in bold above are other common disorders which have been found to respond well to acupuncture.

This article originally appeared on http://www.acupuncture.org.au