Beneficial “Thorns” In Your Side?

Sunday, November 6, 2005

By: Jessica Franke


The idea seems counterintuitive: treat a disease characterized by multiple tender points throughout the body—by being stuck by needles? And yet acupuncture is being increasingly targeted as a possible treatment for the pain of fibromyalgia.

Background
Acupuncture is an important part of traditional Chinese medicine, which is based on the theory that the basic life force called “Qi” (pronounced “chee”) flows through the mind and body and causes illness when imbalanced.  Qi is thought to flow via pathways called meridians, which are accessible through the approximately 400 (some claim over 2000) acupuncture points in the human body.

Since each meridian is thought to control a different organ system or function, stimulating a certain combination of so-called “acupoints” with hair-thin needles could rebalance Qi and restore health. (Meridians do not correspond to Western medicine’s physiological systems.) However, since all the meridians are connected through this energy force, the acupuncture treatment for a headache may involve placing needles in the foot or some other part of the body.

Acupuncture has been utilized in the treatment of everything from menstrual cramps to nausea to post-surgical pain. Recently it has appeared as a promising treatment for fibromyalgia pain.

How can this ancient philosophy be explained by modern-day Western medicine? Studies have found an increase in blood flow to the areas of needle insertion, along with a release of the feel-good hormones called endorphins that are also released during exercise and sex.

Dr. David Martin, MD, PhD, a Mayo Clinic anesthesiologist and a researcher of acupuncture and FM, explained in a press release: “In a Western view of medicine, we’re modulating sensory input through acupuncture.  Whenever there’s an input to the nervous system, it responds and adapts to the input—sometimes in ways that are beneficial to patients. This is not so different from the traditional Eastern explanation of acupuncture that describes needles as altering the flow of life energy, called Qi.”

With our unbelievably complex nervous system, it is certainly possible that a needle in the foot could act in some as yet unknown way to relieve a headache. Western science is currently bustling to discover the mechanism by which acupuncture has helped millions of patients with millions of different symptoms throughout its 3,500 year history.


It makes sense that acupuncture could be useful in treating fibromyalgia, as the disease is thought to involve a general dysregulation of the central nervous system: FM could be the quintessential example of imbalanced “Qi.”


Current Research

However, Western science has been running into some problems researching acupuncture’s effect on FM. For starters, there is conflicting evidence as to its efficacy. A recent study by the Mayo Clinic found acupuncture to be significantly more effective at relieving FM pain, and secondarily fatigue and anxiety, over a placebo treatment involving “sham” acupuncture. (Placebo treatments either utilize special needles that do not pierce the skin, or needle insertion in non-acupoints or acupoints not implicated in pain treatment [for example, in acupoints traditionally stimulated to help people quit smoking].)

“This study shows there is something real about acupuncture and its effects on fibromyalgia,” lead investigator Dr. Martin said. “Our study was performed on patients with moderate to severe fibromyalgia. It’s my speculation that if acupuncture works for these patients with recalcitrant fibromyalgia—where previous treatments had not provided satisfactory relief—it would likely work for many of the millions of fibromyalgia patients.”

However, a recent Seattle-based study showed just the opposite: that acupuncture does not significantly improve FM pain over placebo treatments.  How can this be?  Even the study’s researcher, Dr. Dedra Buchwald, expressed surprise at the results in an Associated Press article.

Acupuncture “certainly works in acute pain control and it works in some conditions of chronic pain,” she said. “So I don’t think this is to say that acupuncture doesn’t work at all. We’ve seen it ourselves in our patients, that they swear by it; they have a lot of faith that acupuncture works.”

What happened? Was one study wrong? Probably not. It is extremely difficult to devise an experiment to test acupuncture, especially considering we don’t know precisely how acupuncture exerts its biochemical and physiological effects on the body. There is no standardized protocol for treating FM symptoms, since acupuncturists often tailor treatments to individual patients, a flexibility not allowed in a clinical trial. There appears to be a huge placebo effect involved in being stuck with needles: for example, in the Seattle-based study, all people involved in the study felt better, no matter which treatment they’d received.

Both studies involved a relatively small number of test subjects—50 in the Mayo Clinic study and 100 in the Seattle-based study—and it is hard to provide a stringent control group for acupuncture studies. Patients were allowed to continue their regular treatments, meaning acupuncture was looked at only as an adjunct therapy. Also, the timeline of treatments is important: the Mayo Clinic study involved treatments for only 2-3 weeks, with the greatest improvement one month after treatments. The benefits had completely disappeared seven months later. The Seattle-based study, in contrast, involved 12 weeks of treatments and saw no statistically significant benefits, aside from a probably placebo-based peak one week into the study.

The bottom line: we need more research.

To Poke or Not To Poke
But we FM patients need symptom relief now. Should we try acupuncture, or not?
In general, if you are receptive to the idea of acupuncture, it is certainly worth a try. Some of us (like me!) are a little squeamish when it comes to needles, so the anxiety attack brought on by an acupuncture treatment could be counterproductive.

Acupuncture may be a good option for patients who have intolerable side effects from pain-relieving medications, or for patients with stubborn symptoms that have responded to nothing else. There are generally no side effects and slight or no discomfort during the treatment (or so they tell me). And even if the whole being-stuck-with-needles thing does turn out to have a placebo effect, it’s worth it if it works for you.

Once you decide to give it a shot (no pun intended), some practical considerations apply. To find a licensed acupuncture practitioner, talk to your doctor first. Many doctors use acupuncture in their clinical practice, or can recommend a certified acupuncturist, who should be licensed by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). Check the costs and your insurance policy; acupuncture treatments can be expensive. Interview the practitioner to make sure he is familiar with your condition (ask him “pointed” questions); as with any doctor, if at first you don’t succeed, try somebody else.

The initial exam will be much like a doctor’s visit, involving an initial history uptake and exam whereby the practitioner determines what causes are responsible for your symptoms and devises a treatment plan accordingly. Each visit lasts about thirty minutes to an hour. During the visit, the practitioner inserts sterilized, individually wrapped, single-use stainless steel needles into certain places in the body and leaves them in for 15-20 minutes. Acupuncture involving electrical stimulation has been effective in treating FM and so may be an option. Part of the treatment plan may involve lifestyle changes, such as exercise, yoga, better nutrition, or herbal supplements.

Finally, there is an important caveat that I must mention. No matter what the conclusion of the scientific study, they all show that the benefits, if any, of acupuncture will cease when the treatments do. Initially, treatments can occur as frequently as two or three times a week. Some say the frequency can be decreased as symptoms improve, while others say the treatments must be gradually increased to maintain improved health, but treatments will need to continue for as long as you have FM symptoms. Again, since there isn’t even enough research to determine if acupuncture helps or not, there certainly isn’t enough research into its long term effects.

Acupuncture probably won’t hurt you, and could potentially help. But as always, be aware of scams. Keep up on current research findings and treatment recommendations, and as always, watch out for the best interests of your health and your pocketbook. In other words—stay “sharp!”

For more information, visit these websites:
American Academy of Medical Acupuncture
National Center for Complementary and Alternative Medicine
National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM)