World Health Organization - Review of Clinical Acupuncture Trial Reports
By the World Health Organization
Acupuncture has been proven effective in relieving postoperative pain, nausea during pregnancy, nausea and vomiting resulting from chemotherapy, and dental pain with extremely low side effects. It can also alleviate anxiety, panic disorders and insomnia.
The effectiveness of acupuncture analgesia has already been established in controlled clinical studies. As mentioned previously, acupuncture analgesia works better than a placebo for most kinds of pain, and its effective rate in the treatment of chronic pain is comparable with that of morphine. In addition, numerous laboratory studies have provided further evidence of the efficacy of acupuncture's analgesic action as well as an explanation of the mechanism involved. In fact, the excellent analgesic effects of acupuncture have stimulated research on pain.
Because of the side-effects of long-term drug therapy for pain and the risks of dependence, acupuncture analgesia can be regarded as the method of choice for treating many chronically painful conditions.
The analgesic effect of acupuncture has also been reported for the relief of eye pain due to subconjunctival injection, local pain after extubation in children, and pain in thromboangiitis obliterans.
Head and Face
The use of acupuncture for treating chronic pain of the head and face has been studied extensively. For tension headache, migraine and other kinds of headache due to a variety of causes, acupuncture has performed favorably in trials comparing it with standard therapy, sham acupuncture, or mock transcutaneous electrical nerve stimulation (TENS). The results suggest that acupuncture could play a significant role in treating such conditions.
Chronic facial pain, including craniomandibular disorders of muscular origin, also responds well to acupuncture treatments. The effect of acupuncture is comparable with that of stomatognathic treatments for temporomandibular joint pain and dysfunction. Acupuncture may be useful as complementary therapy for this condition, as the two treatments probably have a different basis of action.
Chronically painful conditions of the locomotor system accompanied by restricted movements of the joints are often treated with acupuncture if surgical intervention is not necessary. Acupuncture not only alleviates pain, it also reduces muscle spasm, thereby increasing mobility. Joint damage often results from muscle malfunction, and many patients complain of arthralgia before any changes are demonstrable by X-ray. In these cases, acupuncture may bring about a permanent cure. Controlled studies on common diseases and conditions in this category have been reported by different authors, with favorable results for acupuncture treatments compared with standard therapy, delayed-treatment controls, control needling, mock TENS, or other sham acupuncture techniques. The conditions concerned include cervical spondylitis or neck pain due to other causes, periarthritis of the shoulder fibromyalgia, fasciitis, epicondylitis (tennis elbow), low back pain, sciatica, osteoarthritis with knee pain, and radicular and pseudoradicular pain syndromes. In some reports, comparison was made between standard care and acupuncture as an adjunct to standard care. The conclusion from one such randomized controlled trial was that acupuncture is an effective and judicious adjunct to conventional care for patients with osteoarthritis of the knee.
Rheumatoid arthritis is a systemic disease with extra-articular manifestations in most patients. In this disease, dysfunction of the immune system plays a major role, which explains the extra-articular and articular features. Acupuncture is beneficial in the treatment of rheumatoid arthritis. While acupuncture may not improve the damage that has been done to the joints, successful pain relief has been verified in the majority of controlled studies. The action of acupuncture on inflammation and the dysfunctional immune system is also beneficial.
In a randomized controlled trial, blood-pricking acupuncture was compared with conventional medication (allopurinol). The acupuncture group showed greater improvement than the allopurinol group. In addition, a similar reduction of uric acid levels in the blood and urine of both groups was noted. Plum-blossom needling (acupuncture using plum-blossom needles), together with cupping (the application to the skin of cups which are then depressurized), has been recommended for treating gouty arthritis.
Biliary and Renal Colic
Acupuncture is suitable for treating acute pain, provided the relief of pain will not mask the correct diagnosis, for which other treatments may be needed. Biliary and renal colic are two conditions for which acupuncture can be used not only as an analgesic but also as an antispasmodic. In controlled studies on biliary colic and renal colic, acupuncture appears to have advantages over conventional drug treatments (such as intramuscular injection of atropine, pethidine, anisodamine (a Chinese medicine structurally related to atropine, isolated from Anisodus tanguticus), bucinnazine (also known as bucinperazine) or a metamizole-camylofin combination). It provides a better analgesic effect in a shorter time, without side-effects. In addition, acupuncture is effective for relieving abdominal colic, whether it occurs in acute gastroenteritis or is due to gastrointestinal spasm.
Traumatic or Postoperative Pain
For traumas such as sprains, acupuncture is not only useful for relieving pain without the risk of drug dependence, but may also hasten recovery by improving local circulation. Acupuncture analgesia to relieve postoperative pain is well recognized and has been confirmed in controlled studies. The first successful operation under acupuncture analgesia was a tonsillectomy. This was, in fact, inspired by the success of acupuncture in relieving post-tonsillectomy pain. Post-tonsillectomy acupuncture was re-evaluated in a controlled study in 1990, which not only showed prompt alleviation of throat pain, but also reduction in salivation and promotion of healing in the operative wound.
Acupuncture has been widely used in dentistry. There are reports of randomized controlled trials on the analgesic effect of acupuncture for postoperative pain from various dental procedures, including tooth extraction, pulp devitalization , and acute apical periodontitis. According to a systematic review of papers on the use of acupuncture in dentistry published between 1966 and 1996, 11 out of 15 randomized controlled studies with blind controls, appropriate statistics and sufficient follow-up showed standard acupuncture to be more effective than a placebo or sham acupuncture. It was therefore concluded that acupuncture should be considered a reasonable alternative or supplement to current dental practice as an analgesic. Its use in the treatment of temporomandibular dysfunction was also supported in these studies.
In childbirth, acupuncture analgesia is useful for relieving labor pain and can significantly reduce the duration of labor. In the case of weakened uterine contractions, acupuncture increases the activity of the uterus. Episiotomy and subsequent suturing of the perineum can also be carried out with acupuncture analgesia. In addition, the avoidance of narcotics is advantageous for newborn infants.
Acupuncture analgesia has the following advantages in surgical operations. It is a very safe procedure compared with drug anaesthesia; no death has ever been reported from acupuncture analgesia. There is no adverse effect on physiological functions, whereas general anaesthesia often interferes with respiration and blood pressure, for example. There are fewer of the postoperative complications that sometimes occur after general anaesthesia, such as nausea, urinary retention, constipation, and respiratory infections. The patient remains conscious and able to talk with the medical team during the operation so that injury of the facial and recurrent laryngeal nerve can be avoided. However, remaining conscious may be a disadvantage if the patient cannot tolerate the emotional stress of the procedure.
While the benefits of acupuncture analgesia are many, the disadvantages must also be considered. The use of acupuncture is more time-consuming and in many cases may fail to bring about complete analgesia. It is often not suitable for abdominal surgery because suppression of visceral pain and muscle relaxation may be inadequate. It is not suitable in children because few children will tolerate the needling and keep still during major surgery. Also, the surgeon must be quick and deft, so that the operation can be finished before the patient develops tolerance to the needling.
In conclusion, acupuncture analgesia as an anaesthetic for surgical procedures is indicated in selected patients who show a good response to needling in the preoperative trial, particularly when they may be a poor surgical risk under conventional general anaesthesia. The use of adjuvant drugs to potentiate the effect of the acupuncture treatment is preferred. Acupuncture can also be used in combination with general anaesthesia.