WWhen the opioid addiction crisis began to rage in the United States about a decade ago, Dr. Medhat Mikhail spent a lot of time talking to his patients about other ways to treat pain besides opioids, from other types of medication to alternative therapies.
As a pain management specialist at Memorial Care Orange Coast Medical Center in Fountain Valley, California, he wasn’t expecting to leave behind completely short-term opioid use, because they work so well for postoperative pain. But he wanted to recommend a safer and more effective treatment.
It turned out that that was acupuncture.
“Like any treatment, acupuncture does not work for everyone, but the majority of my patients who have tried it have found relief,” he says. “When I started looking at the studies, I discovered the amount of evidence behind this treatment, and that made me feel comfortable suggesting it as an alternative or supplement to pain medications and other treatments.”
This combination of anecdotal success, research-backed results, and a growing level of openness from the medical community are all driving the popularity of acupuncture as a treatment. According to a 2021 WHO report, acupuncture is the most widely used traditional medicine practice worldwide, and it’s gaining traction in the United States In 2020, the Centers for Medicare and Medicaid Services began covering acupuncture for the first time for chronic low back pain.
Although scientists do not yet understand all the nuances of how it works, research indicates that it can have a significant impact on certain conditions, and show promise for others.
What is acupuncture?
The goal of acupuncture is the same now as it was thousands of years ago when it was first developed in China: to restore balance to the body, says Kevin Menard, MD, a sports medicine acupuncturist and practitioner of traditional Chinese medicine in Sag Harbor, New York.
This practice depends on how the energy is used, or chiit flows through the body along a series of channels called meridians — similar to the way nerves and vessels carry messages and blood throughout each organ.
“According to Chinese medicine theory, each meridian is associated with a specific organ, and placing thin needles at certain points along these meridians can cause certain changes in the body to restore balance,” says Maynard. Needles are not the kind you use to draw blood; It is very thin and flexible, almost similar to wire parts.
It is believed that placing it along the meridians causes reactions such as sending more blood or lymphatic fluid to certain organs or allowing muscles to release in a way that reduces stress on joints and bones.. The needles may also stimulate nerves and modify the regulation of the nervous system to trigger a relaxation response, Mikhail says, relieving pain.
Maynard also believes that acupuncture stimulates the immune system and controls inflammation, two effects that can bring benefits throughout the body. Depending on the condition or injury, relief may occur with just one treatment, but it usually takes a series of sessions, says Maynard, especially if the problem is complex or chronic.
What does the research say?
Research on acupuncture has been extensive, and to date, strong evidence supports its effectiveness in some, but not all, cases. According to an analysis published in February 2022 in the newspaper BMJ who analyzed more than 2,000 scientific reviews of acupuncture treatments, the science is the strongest behind the effectiveness of acupuncture for post-stroke aphasia; Neck, shoulder and muscle pain. Fibromyalgia pain. Breastfeeding problems after childbirth. lower back pain; Symptoms of vascular dementia. and allergy symptoms.
The National Institutes of Health (NIH) has found that acupuncture for pain relief tends to have the most evidence, especially for conditions that have become chronic such as osteoarthritis and low back pain, as well as tension headaches. A review of 11 clinical trials also suggests that acupuncture may help treat symptoms associated with cancer treatment, the National Institutes of Health notes.
This has been a burgeoning area of interest in the field, which focuses on integrative health professions, such as acupuncture, chiropractic, and traditional Chinese medicine, says Sarah Weaver, an acupuncturist and massage therapist at Northwestern University of Health Sciences in Minnesota. For cancer patients, sessions there can focus on reducing the nausea, numbness and tingling (called neuropathy), brain fog, decreased appetite, acute and chronic pain, and the mood challenges that come with cancer care.
“Often, people with cancer want a complementary treatment that doesn’t affect chemotherapy or radiation, and this is where an option like acupuncture can be beneficial,” she says. “This is why more health care systems are incorporating this treatment into their integrated care options.”
What is next in this field?
Acupuncture is not a proven, accepted treatment in most cases—even for the most promising. This is partly because the studies supporting it are sometimes not of high quality, and the field lacks standardized protocols that would allow it to be better scientifically evaluated, according to a recent WHO report.
For example, a 2016 research review analyzed studies looking at acupuncture for substance abuse and addiction. Of the 83 research articles included in the review, researchers found significant differences in study quality, acupuncture frequency, how long the needles were left in the body during treatment, which points along the meridians were used, and other potentially important factors. This made it difficult to assess how effective acupuncture really was. The researchers argue that the field also lacks clear terminology and universally accepted agreement about the location of acupuncture points.
Such issues should be resolved to gain greater clarity, and obtain recommendations from reputable organizations in the future. International experts in the field strive to make clinical trials more rigorous in order to demonstrate the usefulness of acupuncture in patient care and to help providers adopt best practices as more benefits become apparent.
Some potential directions for future studies include studying how acupuncture affects hormonal regulation, such as relieving menopausal hot flashes or treating menstrual disorders. Research suggests that this practice can boost estrogen and other hormones, and acupuncture for gynecological problems is becoming more common, Maynard says. Some researchers are also focusing on studying the effect of acupuncture on fertility. Some small preliminary studies suggest that its use may be linked to earlier pregnancy and better results than IVF treatments.
Acupuncture for mental health issues such as depression and anxiety is another major research direction, particularly regarding how these issues affect overall health. For example, chronic pain is often linked to symptoms of depression, so researchers are investigating whether acupuncture can treat both: a person’s pain and depression. The researchers are optimistic. A study published in 2020 in the journal Frontiers in Neuroscience It found that people with migraines who had acupuncture treatments had a lower risk of depression and anxiety, and tended to use medical services more often, compared to migraine patients who didn’t have acupuncture.
As the evidence base expands, the popularity of acupuncture will likely continue to grow. Although acupuncture has been used for centuries, only in the past decade has there been a seismic shift in acceptance by both Western physicians and patients, Maynard says. Ongoing research efforts and increased interest from health systems mean that the treatment may be part of more conversations like Mikhail has had with his patients.
“At the end of the day, clinicians want their patients to feel better, and many people are looking for non-pharmaceutical pathways to wellness,” Maynard says. “Depending on the situation, these little needles can make a big impact.”
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