Acupuncture may finally be poised to earn some long-sought respect from the medical establishment -- and perhaps better insurance coverage -- with a new clinical trial showing that the technique works better than a sham treatment to relieve not just pain but other symptoms that are less subjective to measure.
The small but well designed study, published Monday in the Archives of Internal Medicine, involved 68 Japanese patients with difficulty walking and breathing from a chronic lung condition. Half were randomly assigned to have acupuncture with hair-thin needles that penetrated the skin -- to press on certain pressure points -- while the other half had fake treatments using blunt needles that didn’t pierce the skin.
After 12 weeks, those who received the real acupuncture were able to walk and breathe more easily during a six-minute walk test, while those who had the fake treatments experienced no improvement in their previous walking test scores.
The paper suggests acupuncture may be a potential treatment for a lung condition -- called chronic obstructive pulmonary lung disease -- that doesn’t have many effective treatments to halt the lung deterioration that leads to the need for an oxygen tank for breathing and eventually can be fatal.
The study is “thoughtful and methodologically rigorous, indicating that acupuncture creates significant improvement for patients with COPD across a range of patient-centered and physiologic outcome measures over and above standard care,” wrote George Lewith, a researcher from the University of Southampton, in an editorial that accompanied the study.
But he also told me via e-mail that it’s too early for acupuncture to become the standard of care to treat the lung condition; results need to be replicated in larger studies.
A bigger issue is the wide variation in acupuncture practices, even among practitioners in a single city such as Boston. The researchers used a traditional Chinese medical (TCM) acunpuncture technique, pressing on a standard set of pressure points in a prescribed order. Having a standardized practice is common in clinical trials, said acupuncture researcher Vitaly Napadow, an assistant professor of radiology at Massachusetts General Hospital.
But, he added, “there is very little agreement as to how acupuncture should be practiced” in the real world. As part of his training at the New England School of Acupuncture, Napadow said he studied TCM as well as techniques from Korea and other countries and learned to personalize treatment plans, even for patients with the same medical diagnoses.
Having research studies that document effectiveness for specific acupuncture techniques, however, might help convince some acupuncturists -- especially those affiliated with academic teaching hospitals -- to follow standard techniques proven effective by research.
A large review of clinical trials testing acupuncture against sham treatments for arthritis, back pain, and other chronic pain conditions is slated to be published soon, according to Napadow, and it clearly shows that the real pinpricks are better than the fake ones. Interestingly, it also found that even fake treatments work better than other placebos, such as a doctor visit without touching any pressure points.
Another review of 21 studies recently published online found that acupuncture was effective at combating nausea after surgery, and others show acupuncture can help alleviate migraines and improve outcomes of in vitro fertilization.
How acupuncture works depends on whom you ask. Chinese philosophers believe the body has an energy flow that runs like rivers, or meridians, which can get blocked up as if behind a dam at certain points, leading to illness. The needle treatment unblocks this dam making the body healthy again.
Western scientists, however, hypothesize that acupuncture likely works by stimulating the central nervous system at various pressure points, releasing chemicals into the muscles, spinal cord, and brain. These chemicals may alter the brain’s perception of pain or release other chemicals that influence self-regulating systems like breathing or digestion.
“Usually the benefits don’t occur after one treatment,” Napadow said. “It requires a minimum once-a-week treatment for several weeks, but some practitioners advise twice a week for those in severe pain.”
In China, some get treated every day with acupuncture, but treatments are much cheaper there. In this country, treatments run $50 to $125 per session and often aren’t covered by insurance. Veterans Acupuncture Care offers free sessions every Saturday in Framingham to veterans and their families. And the New England School of Acupuncture offers reduced prices for sessions conducted by students in training.
Insurance coverage might improve in the future, Napadow added, if larger clinical trials demonstrate acupuncture’s effectiveness over sham procedures and practitioners are willing to adopt standardized practices.