There has been growing interest in the West about the application
of acupuncture to control pain since President Nixon’s
well-publicized trip to China in 1971. The fascination with this
ancient medical modality was heightened when one of the members
of the press corps, James Reston, received acupuncture during an
Despite the initial enthusiasm, there continues to be skepticism
regarding the efficacy of acupuncture. Given the lack of definitive
clinical data, some of the skepticism is warranted. Acupuncture, however,
is not alone in this regard when it comes to pain treatments, and
much of the standard clinical care provided by pain physicians stands
on less secure ground. The publication of the National Institutes
of Health (NIH) consensus statement in 1998 on the clinical applications
of acupuncture was based on over 2000 scientific articles and has
put acupuncture on more solid ground in the medical community (the
citations are available at the web site of the National Library
of Medicine).1 Although clearly not a universal
panacea for all pain syndromes, acupuncture has held up well under
the last 20 years of scientific scrutiny and seems destined to continue
as a viable method for the treatment of pain.
The goal of this chapter is to lay the basic theoretic and physiologic
groundwork for understanding the clinical applications of acupuncture
for pain. Then the current clinical data regarding the efficacy
of acupuncture in various pain syndromes is discussed. Finally,
a brief representation of some of the different treatment styles
for common pain syndromes is outlined, and the chapter concludes
by identifying further educational resources in this field.
The term acupuncture comes from the Greek words acus (needle)
and punctura (puncture) and is the English translation of chan in
Mandarin and hari in Japanese.
The clinical practice of inserting needles into the body (initially
stone or flint needles) occurred in China by the fifth century bc
and was followed some time later, between the 2nd and 3rd century bc,
by the first written medical text on acupuncture, the Huang Di Nei
Jing or the Yellow Emperor’s Classic of Internal Medicine.
Chinese Taoist theories of yin and yang, or the balance of opposing
influences in nature, underlie the theoretical framework used in
acupuncture to understand human health. Human beings are seen as
an integral part of a larger macrocosm that includes all the elements
of the surrounding world. These elements are seen to have varying
degrees of influence on the human organism and factors such as weather,
diet, and social environment are all taken to have significant effects
on an individual’s health. The dynamic balance of these
external factors, together with the internal physical and emotional
state of the organism, interact to influence health and disease.
As a correlate to this holistic view of human health, Chinese medicine
makes no distinction between mental and physical illness and the
mind-body dualism that plagues Western medical ...