Does Acupuncture Work? It's A Prickly Subject
JOE SCHWARCZ - Freelance
Montreal Gazette, Canada
Sunday, May 09, 2004

Last week, I left you sitting on pins and needles waiting to hear about the scientific evidence for acupuncture.

I described how researchers in Germany had developed a device that allowed an acupuncture needle to retract into the
handle, giving the appearance it had been inserted into the skin. They used this "sham" procedure to investigate the
value of acupuncture in controlling post-operative nausea and vomiting. Anecdotal evidence, along with some previous
nonplacebo controlled studies had suggested the nausea commonly experienced after general anesthesia could be reduced
through acupuncture. More than 200 women undergoing breast or gynecologic surgery were in the study, with half
receiving the sham treatment and half having real needles inserted into an acupuncture point on their forearm.
Stimulation of this "Pericardium 6" point is traditionally believed to control nausea.

In this experiment, it didn't. There was no significant difference in postoperative nausea between the two groups but
the patients who had undergone acupuncture did have less of a tendency to vomit. Acupuncturists argue the results would
have been different if several more points had been stimulated. Perhaps.

Since the 1970s, more than 500 studies of acupuncture have been published in peer-reviewed scientific journals.
Conditions ranging from asthma, drug addiction and weight reduction to smoking cessation, stroke and tinnitus (ringing
in the ear) have been examined. One would think so many studies should be able to clarify what acupuncture can and
cannot do. Alas, such is not the case. There is much contradictory and inconclusive evidence, as is obvious from an
excellent recent review published in the Annals of Internal Medicine, a highly respected journal. Ted Kaptchuck of
Harvard Medical School surveyed the literature for the best controlled trials and categorized these in terms of the
conditions they attempted to treat and the results they found. Kaptchuk holds a degree in Oriental Medicine and uses
acupuncture, so he certainly is not biased against the technique.

"Good" evidence was found for alleviation of dental pain, reduced vomiting after surgery or chemotherapy and nausea
associated with pregnancy. For chronic pain, headaches, back pain, asthma and smoking cessation the evidence was
contradictory, while for addiction and tinnitus it was negative. A British study just released has, however, shown
weekly acupuncture in combination with appropriate medication can reduce the number of days migraine patients suffer a
headache more than medication alone. How do we explain the contradictory evidence for the treatment of pain? How can it
be that some studies show significant positive results but others come up empty? As with other treatments, the
expertise of the therapist is undoubtedly important.

Physicians who are trained in acupuncture are the most likely to select the best candidates for treatment, and, of
course, are also adept at diagnosing conditions that require a more orthodox approach.

In other words, you have to know when to reach for the antibiotic or the scalpel, and when to reach for the acupuncture
needles. The specific nature of the acupuncture technique is also important. Many of the positive results are seen when
electrical stimulation is applied through the needles.

Given that acupuncture can in some cases produce positive results, we are saddled with the question of "how?"

One explanation involves the production of pain-killing substances by the body when stimulated by acupuncture. These
"endorphins" are also produced in times of stress and could explain why soldiers often don't feel wounds until after
the heat of the battle. Some studies have shown that naloxone, a drug which blocks the activity of the endorphins, can
also negate the benefits of acupuncture.

Professor Ronald Melzack of McGill University, regarded as one of the top experts on pain in the world, points out
acupuncture is not some magical process, but is just one of many methods that can relieve pain by sensory
hyperstimulation.

Flood the body with sensory input, he suggests, and there will be pain relief. And I believe him. Many years ago, I had
the pleasure of listening to one of Professor Melzack's lectures in which he described how rubbing an ice cube on the
skin between the thumb and forefinger can alleviate a toothache. "Hmmmm," skeptical me thought at the time. Then it
happened. I woke up one night with a terrible toothache. I took Aspirin, I applied oil of cloves to my gums, but
nothing helped. Out of desperation I reached for an ice cube and (feeling somewhat foolish) began to massage my hand.
Within minutes there was blessed relief! Endorphin release? Opening up of "qi" channels? Placebo effect? Who cares! The
pain was gone.

The answer to what happened may eventually come from functional magnetic resonance imaging (fMRI) studies of the brain.
Scans of this type have already revealed when subjects' fingers are immersed in hot water, certain areas of the brain
are activated and the activity is reduced with acupuncture. But whether the needles are inserted along "meridians," or
elsewhere, seems to make no difference.

What then are we to conclude from all this? That acupuncture works in the hands of some practitioners, for some
conditions, for some patients, some of the time. This may not sound too optimistic, but the same can be said about a
number of "orthodox" medical treatments. The best bets for acupuncture seem to be in the areas of dental pain, nausea
and migraine. Risks are minor; they are the ones associated with any needle use. So, as you can see, the facts don't
pop the acupuncture balloon, but perhaps they do deflate it somewhat.

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Joe Schwarcz is director of McGill University's Office for Science and \Society (www.OSS.McGill.ca). He can be heard
every Sunday from 3-4 p.m. on CJAD. [log in to unmask]

SOURCE: Montreal Gazette, Canada - May 9, 2004
http://tinyurl.com/yqpzn

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