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Acupuncture
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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 a member of the press corps, James Reston, received acupuncture during an appendectomy. The subsequent publication in 1998 of the National Institutes of Health (NIH) consensus statement on the clinical applications of acupuncture based on over 2000 scientific articles brought a degree of optimism that acupuncture would become a mainstay in the war against pain.1
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There has been some dampening of the initial enthusiasm, however, with continued skepticism regarding the efficacy of acupuncture. This skepticism arose from the lack of high-quality randomized controlled clinical trials (RCTs); but the results of a number of recent large RCTs using sham acupuncture controls have nevertheless left many believing that acupuncture is just an elaborate placebo ritual.2 As we shall discuss in more detail, the introduction of sham acupuncture has serious flaws but was based on the desire of researchers to filter the clinical practice of acupuncture through the mesh of standard placebo controlled methodology used in pharmacological research. Although clearly not a universal panacea for all pain syndromes, a more careful reading of the literature in fact does support that acupuncture is a cost-effective method for the treatment of pain.
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The goal of this chapter is to lay the basic theoretical and physiological groundwork for understanding the clinical applications of acupuncture for pain. Then the current clinical data regarding the efficacy of acupuncture in various pain syndromes will be discussed. Attention will be given to understanding the pitfalls in devising a true placebo control for acupuncture trials, and our discussion of the literature will focus on the effect this has had on the outcomes of a number of large clinical trials for common pain conditions. 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.
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BRIEF HISTORY OF ACUPUNCTURE
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The term acupuncture is from the Greek acus, “needle,” and punctura, “puncture”; it is the English translation of chan in Mandarin and hari in Japanese.
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The clinical practice of inserting needles into the body (initially stone or flint needles) occurred in China by the 5th centuries BC and was followed some time later, between the 2nd and 3rd centuries BC, by the first written medical text on Chinese medicine, the Huang Di Nei Jing, or the Yellow Emperor's Classic of Internal Medicine. In this text, acupuncture was the most cited treatment method, with Chinese herbal therapies endorsed more cautiously because they were considered dangerous and potentially lethal if used incorrectly. In China, there was a slow evolution of practice, and by the 19th century, acupuncture ...