Acupuncture - does it work?
Dr Peter Davies MB,BS; DRCOG; DRACOG; M SC; Grad Dip Ed; FACRRM 1999

Although acupuncture has been practised in Asia for thousands of years, it has only recently taken hold in the West, and is often viewed by Westerners doctors with skepticism. There are many reasons for this;

1. a lack of personal experience with acupuncture (3% of medical acupuncturists live in SA)
2. currently accepted scientific theories of physiology are unable to account for some of the effects of acupuncture
3. there are relatively few scientific studies investigating acupuncture
4. traditional Chinese explanations of how acupuncture works have no relevance in the context of western anatomy and physiology
5. acupuncture is not widely practised in teaching hospital is South Australia
6. acupuncture is not taught in medical schools in South Australia.

Because acupuncture is accepted institutionally in China, large scale, well funded studies are possible there. However, Chinese research is conducted in a cultural context of acceptance of the general efficacy of acupuncture, so their research is often designed to compare the relative effectiveness of one acupuncture technique with another. This kind of research, though quite useful in adding to the knowledge base of acupuncture therapeutics, is useful in convincing skeptics about the effectiveness of acupuncture.

Chinese research rarely meets the "conventional"double blind gold standard. Double-blind trails in acupuncture are very difficult to design (as they are for any procedural treatment). In spite of this difficulty, there does exist a small but growing literature of controlled clinical studies demonstrating the effectiveness of acupuncture in treating a variety of common symptoms and illnesses. All of the findings mentioned in the studies below are statistically significant. The fact that some studies have small subject groups does not make the outcomes less meaningful; it simply means that a relatively more robust effect size was necessary in order to have obtained the significant results reported. Similarly, the fact that some of the individualized aspect of acupuncture treatment may have been compromised in the interest of research protocols should not lead one to discredit findings favourable to acupuncture.

One more note: Does acupuncture work? and Why and how does acupuncture work? are two separate questions. This summary is only concerned with Does acupuncture work?

Addiction Lipton et al (1994) investigated ear acupuncture in treatment of cocaine dependency over a one_month period. 150 patients were randomly assigned to an experimental group and a placebo_control group (patients received ear acupuncture at points not commonly used for addiction treatment).

After two weeks of treatment, the experimental group showed significantly lower cocaine metabolite levels in urine specimens than the placebo group. Konefal, Duncan and Clemence (1994) randomized substance abuse patients at a treatment clinic into three groups: 1) usual care, 2) usual care plus frequent urine testing, 3) usual care, frequent urine testing, and acupuncture. Patients in the acupuncture group became clean (negative urine test) in 57% of the time required for the frequent urine testing group. Bullock, et al (1989) treated 40 severe recidivist alcoholics with acupuncture at points specific to substance abuse (treatment group), and 40 subjects with acupuncture at non_specific points (control group). Significant differences were found at the time of a six_month follow_up: more of the control group expressed a moderate to strong need for alcohol, and the control group had twice the number of both drinking episodes and admissions to a detoxification centre. Clavel_Chapelon et al (1997) showed that acupuncture was comparable to nicotine gum in long term smoking cessation programs.

Angina Pectoris et al (1991) compared acupuncture with placebo tablet treatment in a cross_over design with 21 angina pectoris patients. The patients' symptoms were significantly improved during the acupuncture period compared to the placebo period.

The measures used were number of anginal attacks (6.1 vs. 10.6), performance before onset of pain during exercise (82 W vs. 94 W), and intensity of pain at maximal workload (1.4 vs. 0.8). A life quality questionnaire confirmed improved feeling of well_being. Zhou and Liu (1993) investigated the effect of acupuncture on exercise_induced pain in sufferers of angina pectoris. 15 subjects were blindly randomized into an acupuncture group (n=5) and control groups: sham acupuncture (n=5), and no treatment (n=5). The group that received acupuncture was able to exercise significantly longer than either of the two control groups before onset of anginal attack, with no significant difference between the two control groups. Also the anginal pain decreased more quickly after cessation of exercise in the acupuncture group than in either of the control groups. Ballegard et al (1986) randomized 26 stable angina pectoris patients resistant to medical treatment into true and sham acupuncture groups. It was found that the acupuncture group showed a significantly greater improvement in work capacity than the placebo group, as measured in exercise tests.

Cardiovascular Fitness Ehrlich at al (1992) studied the effect of acupuncture on physical performance in healthy subjects.36 healthy young men were divided into 3 groups: acupuncture treatment, placebo acupuncture, and no treatment.

Performance was measured using a spiro_ergometer test at the beginning and end of a five_week period, with one treatment session per week. The subjects from the true acupuncture group improved significantly in maximum performance and also physical performance at the anaerobic threshold, whereas the control groups showed no improvement.

Cervical Pain Coan et al ( 1981) studied 30 patients with cervical spine pain persisting a mean of 8 years. They were assigned randomly into equal size acupuncture groups and control groups. After 12 weeks 80% of the treated group showed improvement, with a mean 40 % reduction of pain score, 54% reduction of pills, 68% reduction of pain hours per day and 32% less limitation of activity. In comparison, only 13% of the control group reported any improvement, with a mean of 2% worsening of the pain score, 10% reduction in pain pills, no lessening of pain hours, and only 12% less limitation of activity.

Dental Pain Lao, et. al. (1995) compared acupuncture vs. placebo acupuncture as a supplement to standard anaesthesia during surgical third molar extraction.

They found that the group of patients receiving acupuncture (n=11) reported statistically significant longer pain_free time durations after surgery, as well as less pain intensity than the placebo group (n=8). Simmons et al (1993) found that subjects receiving auricular electro_acupuncture (n=20) experienced a statistically significant 18% elevation in dental pain threshold as measured by a hand_held dental pulp tester. A placebo group (n=20) remained essentially unchanged in dental pain threshold.

List (1992) compared the effectiveness of acupuncture and conventional occlusal splint therapy in treating cranio-mandibular disorder (CMD). 110 patients were randomly assigned to an acupuncture group, an occlusal splint therapy group and a control group. Immediately after the treatment, and at six and twelve month follow_up investigations, both acupuncture and the standard splint therapy were found to reduce clinical and subjective symptoms of CMD at a statistically significant level, while the control group was essentially unchanged. The effect of acupuncture and conventional treatment were found to be equivalent with no statistically significant differences across all ten assessment variables used in the study.

Dysmenorrhea Helms (1987) investigated the effectiveness of acupuncture in managing the pain of primary Dysmenorrhea in a randomized and controlled prospective clinical study. 43 women were followed for a year in one of four groups: Real acupuncture(n=11), placebo acupuncture(n=11), no_treatment control group(n=11), and office_visit only control group (n=10). 90.9% of the true acupuncture group showed improvement compared to 36.4%, 18.4% and 10% respectively in the other groups. There was a 41% reduction in medication used by the acupuncture group and no reduction in the other groups.

Lower Back Pain Macdonald et al (1983) studied the efficacy of acupuncture as a treatment for lower back pain in a randomized, single_blind placebo_controlled design. The group receiving acupuncture showed better responses than the placebo group in all five of the outcome measures used, with statistical significance in four of the five. Also an overall mean for all five measures showed significant superiority of acupuncture over placebo.

Garvey, Marks, and Wiesel (1989), in a study on trigger_point injection therapy on 63 patients with chronic low back pain, found that acupuncture was at least as effective as, and possibly superior to injected medication. Therapy without injected medication (acupuncture and acupressure) yielded a 63% improvement rate, while therapy with injection yielded a 42% improvement rate.

Thomas et al (1994) compared the effect of three different modes of acupuncture stimulation on chronic lower back pain. 40 subjects were randomized into 4 groups: manual acupuncture, low_frequency electro_acupuncture (2hz), high_frequency electro_acupuncture (80 Hz), and a waiting list no_treatment control group. After six weeks, all three acupuncture groups showed significant improvement compared to the controls, while after six months the low_frequency group showed superior results compared with the manual stimulation group and the high_frequency group.

Migraine and Headache Vincent (1989) conducted a randomized controlled trial comparing true and sham acupuncture on 30 chronic migraine sufferers.True acupuncture was found to be significantly more effective than sham.

Post_treatment reduction in pain scores for true acupuncture were 43% and reduction in medication was 38%. Both improvements were maintained at 4_month and 1_year follow up.

Hansen and Hansen (1985) compared true and placebo acupuncture in 18 patients suffering from chronic tension headache (mean disease duration: 15 years). Each patient was treated for six weeks with true acupuncture and for six weeks with placebo acupuncture. A 31% reduction in pain was found, with significantly greater effect in true acupuncture than placebo.

Hesse et al; Simon (1994) compared the effect of acupuncture and drug therapy (metoprolol) in preventing headaches in chronic migraine sufferers. 85 patients were randomly assigned to two groups: One received acupuncture plus placebo tablets daily, the other received 100 mg metoprolol plus sham acupuncture. Both groups exhibited significant reduction in frequency and duration of attacks, with no significant difference between the groups. The authors found acupuncture to be superior with regard to side_effects.

Vincent (1990) evaluated the efficacy of acupuncture in treating tension headache, using a single_case design with time_series analysis. Each of fourteen patients was given 8 weekly treatments, four of true acupuncture and four of sham acupuncture in random order. Overall, a significant reduction of pain was found in half of the patients, which was maintained at four_month follow up. True acupuncture was shown to be significantly superior to sham in four patients only with no difference observed in the remainder. However, the design of the experiment (randomly varying true and sham acupuncture treatments, over the course of 8 weeks) may have been insensitive to the cumulative therapeutic effect of acupuncture over a course of treatments.

Carlsson et al (1990) compared the effect of acupuncture and physiotherapy on 62 chronic tension headache patients. The intensity and frequency of headaches was significantly reduced in both the acupuncture group (31) and the physiotherapy group (31), with a significant superiority in the physiotherapy group. The improvement in both groups persisted unchanged 7_12 months after treatment.

Nausea Dundee et al (1986) conducted two studies evaluating the effectiveness of acupuncture as supplement to pre_medication with opioids to reduce nausea in patients undergoing minor gynecological surgery.

In the first study, one group (n=25) received acupuncture at point P_6 (traditionally used to reduce nausea) along with 100 mg meptazinol, another group (n=25) receiving drug treatment only. In the second study, there were three groups: 25 women receiving acupuncture plus 10 mg nalbuphine, 25 women receiving sham acupuncture plus nalbuphine, and 25 receiving drug treatment only. In both studies, needling for five minutes at P_6 resulted in a significant reduction in peri_operative nausea and vomiting compared with the control groups (including the sham acupuncture group).

Belluomini et al (1994) investigated the effectiveness of acupressure in reducing nausea and vomiting in pregnant women. A treatment group (n=30) self_applied acupressure at the point P_6 for 10 minutes 4 times per day for 7 days. A control group (n=30) used acupressure on a sham acupuncture point. Over the course of the study both groups experienced a reduction in nausea, but the reduction in nausea was significantly greater in the treatment group. Also, both groups experienced a reduction in frequency of vomiting, but there was no significant difference between the groups.

De Aloysio et al (1992) conducted a randomized, double_blind, cross_over, placebo_controlled study on the use of acupressure at P_6 to control nausea in early pregnancy. 60 women were randomly divided into two groups, which switched from treatment condition to placebo_control (sham acupressure) midway through the course of the study. A significant difference was found in the effectiveness of real (60%) vs. placebo treatment (30%).

Allen and Kitching (1994) examined the effect of P_6 acupressure on 46 women undergoing laparotomy for gynecological surgery. 23 subjects received acupressure at P_6, and 23 at a sham site. The treatment group requested significantly less anti_emetic therapy than the control group.

Respiratory Conditions Jobst et al (1986) studied the effect of acupuncture on chronic obstructive pulmonary disease. They found that 12 patients receiving true acupuncture showed significantly greater benefit than a placebo acupuncture group (n=12) in terms of subjective scores of breathlessness and six_minute walking distance.

Fung et al (1986) found that real acupuncture was significantly superior to sham acupuncture in protecting against exercise_induced asthma in nineteen children.

Sleep Buguet et al (1995) studied the somnogenic effect of automassage of point H7 (known traditionally to improve sleep) on six healthy volunteers, using polygraphic electroencephalogram measures. In a double_blind, randomized, cross_over design each subject received H7 stimulation in one night_time session, and placebo stimulation (a non_point on the back of the hand) in another session. It was found that H7 stimulation induced a significant decrease in wakefulness and an increase in non_REM sleep compared to placebo stimulation.

Stroke Johansson et al (1993) investigated the effectiveness of acupuncture as a supplement to physical therapy in recovery from stroke. 78 patients suffering from severe hemiparesis of the left or right side within ten days of stroke onset were randomly divided into a control group (n=40) who received daily physical therapy and a treatment group who additionally received two acupuncture treatments per week for ten weeks. Patients receiving acupuncture recovered faster and to a larger extent than controls with significant differences in measures of balance, mobility, quality of life index, and days spent in hospitals/nursing homes.

Pang (1994) investigated two particular scalp acupuncture techniques (slow_rapid reinforcing_reducing vs. flat_twisting) in order to compare their effectiveness in treating apoplexy following stroke. He found a significant superiority in the slow_rapid reducing_reinforcing method group (n=52) over the other group (n=33) with respect to improvement in myodynamia and motile functional disturbances of the limbs. While the intention of the study was not to confirm the effectiveness of acupuncture, per se, the results do suggest that differences in technique engender different outcomes.

Tennis Elbow Molsberger and Hille (1994) conducted a placebo_controlled single_blind study of acupuncture in the treatment of chronic tennis elbow pain. The treatment group (n=24) was treated at non_segmental distal points (homolateral leg) while the placebo group was treated with placebo acupuncture avoiding penetration of the skin. Significant differences were found between the results for the two groups. After one treatment, 79.2% of the experimental group reported at least 50% pain reduction, compared to 25% for the placebo group. The pain relief after one treatment lasted 20.2 hours for the true acupuncture group, compared to 1.4 hours in the placebo group.

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