Thursday, April 2, 2015

From National Institute of Health-- Acupuncture: What you need to know

repost from:
https://nccih.nih.gov/health/acupuncture/introduction
National Center for Complementary and Integrative Health (NCCIH)


Acupuncture: What You Need To Know

On this page:

What’s the Bottom Line?

How much do we know about acupuncture?

There have been extensive studies conducted on acupuncture, especially for back and neck pain, osteoarthritis/knee pain, and headache. However, researchers are only beginning to understand whether acupuncture can be helpful for various health conditions.

What do we know about the effectiveness of acupuncture?

Research suggests that acupuncture can help manage certain pain conditions, but evidence about its value for other health issues is uncertain.

What do we know about the safety of acupuncture?

Acupuncture is generally considered safe when performed by an experienced, well-trained practitioner using sterile needles. Improperly performed acupuncture can cause serious side effects.
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What Is Acupuncture?

Acupuncture is a technique in which practitioners stimulate specific points on the body—most often by inserting thin needles through the skin. It is one of the practices used in traditional Chinese medicine.
See the NCCIH Web site for more information on traditional Chinese medicine.
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What the Science Says About the Effectiveness of Acupuncture

Results from a number of studies suggest that acupuncture may help ease types of pain that are often chronic such as low-back pain, neck pain, and osteoarthritis/knee pain. It also may help reduce the frequency of tension headaches and prevent migraine headaches. Therefore, acupuncture appears to be a reasonable option for people with chronic pain to consider. However, clinical practice guidelines are inconsistent in recommendations about acupuncture.
The effects of acupuncture on the brain and body and how best to measure them are only beginning to be understood. Current evidence suggests that many factors—like expectation and belief—that are unrelated to acupuncture needling may play important roles in the beneficial effects of acupuncture on pain.

Read more about acupuncture for these pain conditions and others:

For Low-Back Pain

  • A 2012 analysis of data on participants in acupuncture studies looked at back and neck pain together and found that actual acupuncture was more helpful than either no acupuncture or simulated acupuncture.
  • A 2010 review by the Agency for Healthcare Research and Quality found that acupuncture relieved low-back pain immediately after treatment but not over longer periods of time.
  • A 2008 systematic review of studies on acupuncture for low-back pain found strong evidence that combining acupuncture with usual care helps more than usual care alone. The same review also found strong evidence that there is no difference between the effects of actual and simulated acupuncture in people with low-back pain.
  • Clinical practice guidelines issued by the American Pain Society and the American College of Physicians in 2007 recommend acupuncture as one of several nondrug approaches physicians should consider when patients with chronic low-back pain do not respond to self-care (practices that people can do by themselves, such as remaining active, applying heat, and taking pain-relieving medications).

For Neck Pain

  • A 2014 Australian clinical study involving 282 men and women showed that needle and laser acupuncture were modestly better at relieving knee pain from osteoarthritis than no treatment, but not better than simulated (sham) laser acupuncture. Participants received 8 to 12 actual and simulated acupuncture treatments over 12 weeks. These results are generally consistent with previous studies, which showed that acupuncture is consistently better than no treatment but not necessarily better than simulated acupuncture at relieving osteoarthritis pain.
  • A 2009 analysis found that actual acupuncture was more helpful for neck pain than simulated acupuncture, but the analysis was based on a small amount of evidence (only three studies with small study populations).
  • A large German study with more than 14,000 participants evaluated adding acupuncture to usual care for neck pain. The researchers found that participants reported greater pain relief than those who didn’t receive it; the researchers didn’t test actual acupuncture against simulated acupuncture.

For Osteoarthritis/Knee Pain

  • A 2014 Australian clinical study involving 282 men and women showed that needle and laser acupuncture were modestly better at relieving knee pain from osteoarthritis than no treatment, but not better than simulated (sham) laser acupuncture. Participants received 8 to 12 actual and simulated acupuncture treatments over 12 weeks. These results are generally consistent with previous studies, which showed that acupuncture is consistently better than no treatment but not necessarily better than simulated acupuncture at relieving osteoarthritis pain. 
  • A major 2012 analysis of data on participants in acupuncture studies found that actual acupuncture was more helpful for osteoarthritis pain than simulated acupuncture or no acupuncture.
  • A 2010 systematic review of studies of acupuncture for knee or hip osteoarthritis concluded that actual acupuncture was more helpful for osteoarthritis pain than either simulated acupuncture or no acupuncture. However, the difference between actual and simulated acupuncture was very small, while the difference between acupuncture and no acupuncture was large.

For Headache

  • A 2012 analysis of data on individual participants in acupuncture studies looked at migraine and tension headaches. The analysis showed that actual acupuncture was more effective than either no acupuncture or simulated acupuncture in reducing headache frequency or severity.
  • A 2009 systematic review of studies concluded that actual acupuncture, compared with simulated acupuncture or pain-relieving drugs, helped people with tension-type headaches. A 2008 systematic review of studies suggested that actual acupuncture has a very slight advantage over simulated acupuncture in reducing tension-type headache intensity and the number of headache days per month.
  • A 2009 systematic review found that adding acupuncture to basic care for migraines helped to reduce migraine frequency. However, in studies that compared actual acupuncture with simulated acupuncture, researchers found that the differences between the two treatments may have been due to chance.

For Other Conditions

  • Results of a systematic review that combined data from 11 clinical trials with more than 1,200 participants suggested that acupuncture (and acupuncture point stimulation) may help with certain symptoms associated with cancer treatments.
  • There is not enough evidence to determine if acupuncture can help people with depression.
  • Acupuncture has been promoted as a smoking cessation treatment since the 1970s, but research has not shown that it helps people quit the habit.

Read more about the challenges of studying acupuncture:

Studying acupuncture is challenging because:
  • Clinical trials often differ in terms of technique, the number of acupuncture points, the number of sessions, and the duration of those sessions.
  • Results of an acupuncture session may be associated with a person’s beliefs and expectations about their treatment or from their relationship with the therapist, rather than from acupuncture treatment itself.

What Is Simulated Acupuncture?

In some clinical trials, researchers test a product or practice against an inactive product or technique (called a placebo) to see if the response is due to the test protocol or to something else. Many acupuncture trials rely on a technique called simulated acupuncture, which may use blunt-tipped retractable needles that touch the skin but do not penetrate (in real acupuncture, needles penetrate the skin). Researchers also may simulate acupuncture in other ways. However, in some instances, researchers have observed that simulated acupuncture resulted in some degree of pain relief.
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What the Science Says About Safety and Side Effects of Acupuncture

  • Relatively few complications from using acupuncture have been reported. Still, complications have resulted from use of nonsterile needles and improper delivery of treatments.
  • When not delivered properly, acupuncture can cause serious adverse effects, including infections, punctured organs, collapsed lungs, and injury to the central nervous system.
Read more about what the science says about safety and side effects of acupuncture:
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NCCIH-Funded Research

NCCIH funds research to evaluate acupuncture’s effectiveness for various kinds of pain and other conditions, and to further understand how the body responds to acupuncture and how acupuncture might work. Some recent NCCIH-supported studies are looking at:
  • If acupuncture can reduce the frequency of hot flashes associated with menopause
  • Whether acupuncture can reduce pain and discomfort that may accompany chemotherapy
  • Objectively determining if actual acupuncture is more effective than simulated acupuncture or usual care for pain relief, and (if so) by how much.
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More to Consider

  • Don’t use acupuncture to postpone seeing a health care provider about a health problem.
  • If you decide to visit an acupuncturist, check his or her credentials. Most states require a license, certification, or registration to practice acupuncture; however, education and training standards and requirements for obtaining these vary from state to state. Although a license does not ensure quality of care, it does indicate that the practitioner meets certain standards regarding the knowledge and use of acupuncture. Most states require a diploma from the National Certification Commission for Acupuncture and Oriental Medicine for licensing.
  • Some conventional medical practitioners—including physicians and dentists—practice acupuncture. In addition, national acupuncture organizations (which can be found through libraries or by searching the Internet) may provide referrals to acupuncturists. When considering practitioners, ask about their training and experience.
  • Ask the practitioner about the estimated number of treatments needed and how much each treatment will cost. Some insurance companies may cover the costs of acupuncture, while others may not. For more information, see NCCIH’s fact sheet Paying for Complementary Health Approaches.
Help your health care providers give you better coordinated and safe care by telling them about all the health approaches you use. Give them a full picture of what you do to manage your health. For tips about talking with your health care providers about complementary health approaches, see Time to Talk campaign.
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For More Information

NCCIH Clearinghouse

The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.
Toll-free in the U.S.: 
1-888-644-6226
TTY (for deaf and hard-of-hearing callers): 
1-866-464-3615
Web site: 
nccih.nih.gov
E-mail: 
info@nccih.nih.gov

PubMed®

A service of the National Library of Medicine (NLM), PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals.
Web site: 
www.ncbi.nlm.nih.gov/pubmed

NIH Clinical Research Trials and You

The National Institutes of Health (NIH) has created a Web site, NIH Clinical Research Trials and You, to help people learn about clinical trials, why they matter, and how to participate. The site includes questions and answers about clinical trials, guidance on how to find clinical trials through ClinicalTrials.gov and other resources, and stories about the personal experiences of clinical trial participants. Clinical trials are necessary to find better ways to prevent, diagnose, and treat diseases.
Web site: 
www.nih.gov/health/clinicaltrials/

Research Portfolio Online Reporting Tools Expenditures & Results (RePORTER)

RePORTER is a database of information on federally funded scientific and medical research projects being conducted at research institutions.
Web site: 
projectreporter.nih.gov/reporter.cfm

U.S. Food and Drug Administration (FDA)

The FDA oversees the safety of many products, such as foods, medicines, dietary supplements, medical devices, and cosmetics. Its series of consumer updates includes the publication FDA 101: Dietary Supplements and Tips for Dietary Supplement Users.
Toll-free in the U.S.: 
1-888-463-6332
Web site: 
www.fda.gov
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Key References

Other References

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Acknowledgments

NCCIH thanks the following people for their technical expertise and review of this publication: Lixing Lao, Ph.D., University of Maryland School of Medicine; Karen Sherman, Ph.D., M.P.H., Group Health Research Institute, Seattle; Maria E. Suarez-Almazor, M.D., Ph.D., The University of Texas M.D. Anderson Cancer Center; and Kristin Huntley, Ph.D., Partap Khalsa, D.C., Ph.D., and John (Jack) Killen, Jr., M.D., NCCIH.
This publication is not copyrighted and is in the public domain. Duplication is encouraged.
NCCIH has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCIH.
* Note: PDF files require a viewer such as the free Adobe Reader.
NCCIH Pub No.: 
D404
Date Created: 
December 2007
Last Updated: 
November 2014
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NIH.GOV recommends chiropractic and acupuncture for low back pain


National Center for Complementary and Integrative Health (NCCIH)

Spinal Manipulation for Low-Back Pain

On this page:

Introduction

Low-back pain (often referred to as “lower back pain”) is a common condition that usually improves with self-care (practices that people can do by themselves, such as remaining active, applying heat, and taking pain-relieving medications). However, it is occasionally difficult to treat. Some health care professionals are trained to use a technique called spinal manipulation to relieve low-back pain and improve physical function (the ability to walk and move). This fact sheet provides basic information about low-back pain, summarizes research on spinal manipulation for low-back pain, and suggests sources for additional information.

Key Points

  • Spinal manipulation is one of several options—including exercise, massage, and physical therapy—that can provide mild-to-moderate relief from low-back pain. Spinal manipulation appears to work as well as conventional treatments such as applying heat, using a firm mattress, and taking pain-relieving medications.
  • Spinal manipulation appears to be a generally safe treatment for low-back pain when performed by a trained and licensed practitioner. The most common side effects (e.g., discomfort in the treated area) are minor and go away within 1 to 2 days. Serious complications are very rare.
  • Cauda equina syndrome (CES), a significant narrowing of the lower part of the spinal canal in which nerves become pinched and may cause pain, weakness, loss of feeling in one or both legs, and bowel or bladder problems, may be an extremely rare complication of spinal manipulation. However, it is unclear if there is actually an association between spinal manipulation and CES.
  • Tell all your health care providers about any complementary health practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care. For tips about talking with your health care providers about complementary health approaches see the National Center for Complementary and Integrative Health’s (NCCIH) Time to Talk campaign.

About Low-Back Pain

Back pain is one of the most common health complaints, affecting 8 out of 10 people at some point during their lives. The lower back is the area most often affected. For many people, back pain goes away on its own after a few days or weeks. But for others, the pain becomes chronic and lasts for months or years. Low-back pain can be debilitating, and it is a challenging condition to diagnose, treat, and study. The total annual costs of low-back pain in the United States—including lost wages and reduced productivity—are more than $100 billion.

About Spinal Manipulation

Spinal manipulation—sometimes called “spinal manipulative therapy”—is practiced by health care professionals such as chiropractors, osteopathic physicians, naturopathic physicians, physical therapists, and some medical doctors. Practitioners perform spinal manipulation by using their hands or a device to apply a controlled force to a joint of the spine. The amount of force applied depends on the form of manipulation used. The goal of the treatment is to relieve pain and improve physical functioning.

Side Effects and Risks

Reviews have concluded that spinal manipulation for low-back pain is relatively safe when performed by a trained and licensed practitioner. The most common side effects are generally minor and include feeling tired or temporary soreness.
Reports indicate that cauda equina syndrome (CES), a significant narrowing of the lower part of the spinal canal in which nerves become pinched and may cause pain, weakness, loss of feeling in one or both legs, and bowel or bladder problems, may be an extremely rare complication of spinal manipulation. However, it is unclear if there is actually an association between spinal manipulation and CES, since CES usually occurs without spinal manipulation. In people whose pain is caused by a herniated disc, manipulation of the low back appears to have a very low chance of worsening the herniation.
For risks associated with spinal manipulation affecting the upper (cervical) spine, see the NCCIH fact sheet Chiropractic: An Introduction.

What the Science Says About Spinal Manipulation for Low-Back Pain

Overall, studies have shown that spinal manipulation is one of several options—including exercise, massage, and physical therapy—that can provide mild-to-moderate relief from low-back pain. Spinal manipulation also appears to work as well as conventional treatments such as applying heat, using a firm mattress, and taking pain-relieving medications.
In 2007 guidelines, the American College of Physicians and the American Pain Society included spinal manipulation as one of several treatment options for practitioners to consider when low-back pain does not improve with self-care. More recently, a 2010 Agency for Healthcare Research and Quality (AHRQ) report noted that complementary health therapies, including spinal manipulation, offer additional options to conventional treatments, which often have limited benefit in managing back and neck pain. The AHRQ analysis also found that spinal manipulation was more effective than placebo and as effective as medication in reducing low-back pain intensity. However, the researchers noted inconsistent results when they compared spinal manipulation with massage or physical therapy to reduce low-back pain intensity or disability.
Researchers continue to study spinal manipulation for low-back pain.
  • A 2011 review of 26 clinical trials looked at the effectiveness of different treatments, including spinal manipulation, for chronic low-back pain. The authors concluded that spinal manipulation is as effective as other interventions for reducing pain and improving function.
  • A 2010 review that looked at various manual therapies, such as spinal manipulation and massage, for a range of conditions found strong evidence that spinal manipulation is effective for chronic low-back pain and moderate evidence of its effectiveness for acute low-back pain.
  • A 2009 analysis looked at the evidence from 76 trials that studied the effects of several conventional and complementary health practices for low-back pain. The researchers found that the pain-relieving effects of many treatments, including spinal manipulation, were small and were similar in people with acute or chronic pain.
  • A 2008 review that focused on spinal manipulation for chronic low-back pain found strong evidence that spinal manipulation works as well as a combination of medical care and exercise instruction, moderate evidence that spinal manipulation combined with strengthening exercises works as well as prescription nonsteroidal anti-inflammatory drugs combined with exercises, and limited-to-moderate evidence that spinal manipulation works better than physical therapy and home exercise.
Researchers are investigating whether the effects of spinal manipulation depend on the length and frequency of treatment. In one study funded by NCCIH that examined long-term effects in more than 600 people with low-back pain, results suggested that chiropractic care involving spinal manipulation was at least as effective as conventional medical care for up to 18 months. However, less than 20 percent of participants in this study were pain free at 18 months, regardless of the type of treatment used.
Researchers are also exploring how spinal manipulation affects the body. In an NCCIH-funded study of a small group of people with low-back pain, spinal manipulation affected pain perception in specific ways that other therapies (stationary bicycle and low-back extension exercises) did not.

Managing Low-Back Pain

A review of evidence-based clinical guidelines for managing low-back pain resulted in several recommendations for primary care physicians and pointed to potential benefits of nondrug therapies including spinal manipulation, as well as exercise, massage, and physical therapy:
  • Acute low-back pain: Routine imaging (x-rays or MRIs) generally is not necessary for patients who have had nonspecific low-back pain for a short time. These patients often improve on their own and usually should remain active, learn about back pain and self-care options, and consider nondrug therapies, including spinal manipulation, if pain persists longer than 4 weeks.
  • Chronic low-back pain: Long-term use of opioid drugs usually does not improve functioning for patients with chronic low-back pain. However, these patients may benefit from nondrug therapies, including spinal manipulation. Psychological and social factors also may play a role in chronic low-back pain. Most patients will not become pain free; a realistic outlook focuses on improving function in addition to reducing pain.
To learn more, see the NCCIH Research Spotlight.

NCCIH-Funded Research

Recent NCCIH-supported projects have been investigating:
  • The biomechanisms of spinal manipulation—detailed studies of what happens in the body during manipulation of the low back
  • The best number and frequency of treatments, and the length of care
  • Estimated use, costs, and outcomes of chiropractic care for recurrent back pain.

For More Information

NCCIH Clearinghouse

The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.
Toll-free in the U.S.: 
1-888-644-6226
TTY (for deaf and hard-of-hearing callers): 
1-866-464-3615
Web site: 
nccih.nih.gov
E-mail: 
info@nccih.nih.gov

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

The mission of NIAMS is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases.
Toll-free in the U.S.: 
1-877-22-NIAMS
Web site: 
www.niams.nih.gov

PubMed®

A service of the National Library of Medicine (NLM), PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals.
Web site: 
www.ncbi.nlm.nih.gov/pubmed
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