Unveiling Acupuncture's Efficacy: Beyond the Placebo Effect

In the past, skeptics dismissed the benefits of acupuncture, attributing its effects to a mere placebo response, a notion that still persists in some sections of the public. However, recent research has unveiled significant benefits of this ancient practice, particularly for conditions such as chronic pain. Notably, the Centers for Medicare and Medicaid Services have taken note of the data's promise, leading to the inclusion of acupuncture therapy for chronic low back pain in their coverage.

Over the past several decades, clinical trials have indicated that acupuncture may hold potential as a beneficial treatment for a range of conditions beyond pain, including chronic obstructive pulmonary disease and constipation. To determine the veracity of acupuncture's effectiveness, researchers have conducted comparative studies, pitting it against "sham" acupuncture.

Acupuncture is a therapeutic technique that involves activating specific points, known as acupoints, on the body, typically through the insertion of fine needles. Rooted in traditional East Asian medicine, acupuncture aims to restore the flow of chi, considered the body's vital energy.

In sham acupuncture, practitioners insert needles but deliberately avoid established acupoints. Though not a perfect double-blind system, as trained acupuncturists know when they are administering a sham treatment, from the patient's perspective, the experience is essentially the same. If acupuncture's benefits were solely due to the placebo effect, both the sham and genuine treatments would yield similar results.

However, emerging evidence suggests otherwise. A comprehensive meta-analysis conducted in 2018, encompassing over 20,000 patients across 39 high-quality randomized controlled trials, revealed that real acupuncture surpassed both sham acupuncture and no acupuncture for conditions like back or neck pain, osteoarthritis, headaches, and shoulder pain. Notably, these positive outcomes endured over time, persisting even after 12 months of receiving treatment.

While acupuncture has shown remarkable efficacy, it is essential to acknowledge that it is not a universal panacea. Like any medical intervention, it may not suit everyone's needs. For instance, although it is popular among those undergoing in vitro fertilization treatments, research has indicated that it does not improve fertility outcomes.

The question of how acupuncture operates from a Western medicine perspective has also sparked skepticism. However, researchers have begun to unlock the answer, pointing to the role of the brain in the process. Acupuncture appears to initiate changes in brain activity, particularly in activating receptors that bind opioids, which play a key role in pain control. Moreover, electroacupuncture, involving minor electrical currents to stimulate the needles, has shown the ability to impact different brain regions, essentially rewiring the brain's pain network.

A study investigating carpal tunnel syndrome found that electroacupuncture applied to the afflicted wrist produced similar symptom relief to acupuncture at the opposite ankle. Intriguingly, both groups experienced improvements in how well the median nerve of the wrist transmitted electrical signals, a phenomenon not observed in the sham acupuncture group. This suggests that acupuncture can act locally at the needle insertion site while also exerting effects on distant parts of the body.

The central nervous system likely plays a crucial role in facilitating such responses. Scientists utilized functional MRI imaging to examine the brains of subjects, discovering that needling at both the wrist and ankle led to significant changes in how stimulation to the fingers was mapped onto the cerebral cortex.

While more research is needed to comprehensively understand the mechanisms underlying acupuncture's influence on the body, studies have already provided compelling evidence that it extends beyond mere placebo effects.

Acupoints, defined as specific locations on the human body, appear to respond to various types of stimulation, such as pressure, heat, and electricity. However, much remains to be elucidated regarding how acupoints function. Some studies have suggested that traditional acupoints may have a high density of nerve endings and mast cells, indicating that stimulating these areas could trigger the release of certain chemicals in the body, ultimately impacting the brain.

Unraveling the intricacies of acupoints, their interrelation, and their physiological significance stands as a crucial area of research, supported by funding from the National Institutes of Health.

Acupuncture is generally considered safe when administered by well-trained practitioners. Serious complications or fatalities associated with the practice are exceedingly rare, with fainting or mild pain at the needle insertion site being infrequent adverse effects. The safety profile of acupuncture can sometimes be lower than that of certain pain medications.

As a physician, when recommending acupuncture to patients—particularly for pain or constipation—I do so not as a last resort but rather because of the compelling and substantial data supporting its effectiveness. While biases against treatments not grounded in Western medicine persist, the growing body of evidence underscores acupuncture's potential benefits, making it a viable option for patients seeking relief from various conditions.

Source:The Washington Post


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