Acupuncture

Getting started with acupuncture for chronic pain

Traditional Chinese medicine believes that health is governed by harmony or disharmony in both the body and between the body and nature.

Acupuncture uses fine, solid, metallic needles inserted into specific points on the body. These points fall along 12 primary meridians linked to specific internal organs (e.g., the heart) or along eight secondary meridians that are reservoirs of qi (pronounced “chee,” meaning energy). The needles may be manipulated manually, heat, or with electrical stimulation (electroacupuncture).

Disharmony occurs when the body’s qi is blocked or disrupted somewhere along the meridians. It may seem unbelievable, but these energy lines in the body have been documented by scientific data from the fields of biophysics, biochemistry, and molecular biology. They appear to have electric, acoustic, thermal, optical, magnetic, isotopic, and myoelectric properties that show movement through the body.

Modern research focuses more on what the acupuncture needles (also called pins) do when inserted. According to research, acupuncture pins appear to trigger the body’s productions of endorphins. These pain- and inflammation-relieving chemicals occur naturally in the body. The pins also work in the specific area of insertion by stimulating the connective tissues to begin a healing response. This appears to help relieve pain even in areas away from the insertion point.

Acupuncture for chronic pain also has an effect on your blood pressure, blood flow, and body temperature. These are all regulated by the central nervous system. The thin needles increase the blood flow in the area surrounding the needle. This increase in blood flow supplies nourishment to tissues that promotes healing.

Benefits of acupuncture for different conditions

Acupuncture has shown evidence for managing the following conditions:

• Hay fever and allergies
• Depression and anxiety
• Facial pain
• Headache (including migraine)
• Knee pain
• Low back pain
• Nausea and vomiting
• Neck pain
• Temporomandibular joint disorder (TMJ or TMD)
• Rheumatoid arthritis
• Sciatica

This treatment works well with other treatments, as side effects are rare and not serious, and there is no threat of drug interaction.

History and future of acupuncture

Traditional Chinese medicine practitioners have practiced what is currently known as acupuncture for more than 3,000 years. The first documented use of acupuncture was recorded a few centuries before the Common Era. However, earlier acupuncturists used sharpened bones as far back as 6,000 BCE, making the medical practice of acupuncture closer to 8,000 years old!

Over the years, acupuncture techniques have been further developed to include other ways of accessing the energy points along the body’s meridians. Practices like moxibustion, acupressure, and cupping—alternatives to inserting needles—are also beginning to have some support in the research.

In the United States, two types of practitioners administer acupuncture. Medical doctors (MDs) offer acupuncture as a complementary therapy to their patients, as do alternative providers certified by the National Certification Commission for Acupuncture and Oriental Medicine. Most states require that MDs complete 200 to 300 hours of acupuncture training in addition to their medical training. Alternative providers typically complete 2,000 to 3,000 hours of training.

Is acupuncture effective for chronic pain?

One of the most important benefits of acupuncture for chronic pain is that the procedure is a medication-free way to treat pain.

Although many patients may experience pain relief with pharmaceutical treatments, these treatments come with the risk of overuse and dependence. People with chronic pain conditions taking opioid medications often develop medication tolerance and need an increased dosage to achieve the same effect. Using acupuncture for chronic pain may effectively decrease your pain without medications. It can also be used effectively in conjunction with other treatments.

There are many conditions that benefit from acupuncture for chronic pain, including the following.

Back pain

In the largest study to date, Kaiser Permanente found that acupuncture was more effective than traditional treatments for back pain. It helped people feel better in general and they were more able to participate in their daily activities.

Neck pain

Carefully selected acupuncture points provides pain relief and improved mobility for patients who suffer from neck pain.

Tendon pain

Tendon pain can be challenging to heal and easy to aggravate. Acupuncture provided significant relief in both the short and long-term for patients with Achilles tendinopathy, a condition that can severely limit mobility.

Facial pain

Trigeminal neuralgia is facial pain that stems from damage to the trigeminal nerve. It can be excruciating and debilitating. Acupuncture for facial pain decreased pain successfully for nearly 94% of patients in the study.

Migraine

Patients with chronic migraine pain found significant relief using acupuncture. Their brains were examined using MRI, and researchers found visible changes to the brain before and after treatment.

Mood disorders

There is some conflicting evidence on the effectiveness of treating mood disorders, such as depression and anxiety, with acupuncture. Although there is no clear recommendation to use acupuncture as the sole treatment, there is evidence that acupuncture is effective for improving quality of life when used in conjunction with things like cognitive behavioral therapy and some antidepressant medications.

Circling back to the primary benefit, acupuncture can be used safely even when a patient is taking prescription medications of any kind.

How does acupuncture relieve pain?

Western medicine focuses on acupuncture’s impact on physiological and neurological responses. Two of the neuroscientific mechanisms thought to be influenced by the practice include:

• Central nervous system stimulation: Acupuncture stimulates nerves in your CNS to release pain-suppressing neurotransmitters
• Endorphin release: Part of your body’s natural pain-control system, endorphins are released into the central nervous system when stimulated by acupuncture

As noted above, acupuncture also seems to stimulate the healing response in the body, both at the place where the pin is inserted and at a variety of points along the targeted meridian. In the case of chronic pain, accurately placed acupuncture pins appear to prompt a neurochemical response that helps reduce pain.

What to expect during your appointment

Your first acupuncture appointment will typically be the longest one, about 90 minutes. Your doctor will start by taking a complete medical history, asking about:

• Current condition
• When pain began, and what increases or reduces it
• Family health history
• General lifestyle questions about diet, exercise, etc.
• Other health conditions or complications

If you have been receiving treatment already, your acupuncturist will ask to see test results including lab work, MRIs, X-rays, and any other pertinent information. If your primary care physician has offered a diagnosis, your acupuncturist will ask about that, too.

After, your acupuncturist will then perform a physical examination, assessing you for congestion of qi. They may put the injured area through range of motion exercises to assess mobility and pain levels.

Part of the physical examination is taking your pulses and looking at your tongue. The pulses (taken in both wrists) are an indication of the flow of qi through the body. Traditional Chinese medicine also uses the appearance of the tongue as one of the diagnostic tools for disease in the body.

After they gather this information, your acupuncturist will devise a treatment plan based upon the findings. They will insert a number of needles—between five and 20, usually—and allow you to rest for a period of time with the needles in place.

In some cases, your acupuncturist may stimulate the needles manually, with heat, or with electrical current (electroacupuncture). Needles may also be tipped with burning mugwort, or Artesmisia vulgaris (an herb) for moxibustion. You may feel heaviness, numbness, or tingling after the needles are in place, but they don’t often hurt. The needles usually stay in place for fifteen to thirty minutes.

Recovery period

Once the initial treatment is over, your acupuncturist will check your pulses and may decide to insert another needle or two, either quickly in and out or to rest for a few more moments. After the first session, ongoing sessions last about an hour.

Following treatment, you can return to your usual daily activities. There is little, if any, recovery time needed. Drink plenty of water as you move through your day after receiving acupuncture for chronic pain. Answers to other commonly asked questions follow.

Does acupuncture hurt?

Because the needles used in acupuncture as so fine, most patients don’t even notice when they are inserted. There are a few points in the body that may be more sensitive (i.e., areas on the feet with thinner skin), but your acupuncturist will help you breathe and relax through any discomfort you may experience.

If you are concerned about pain, talk to your acupuncturist ahead of time. They will be able to talk your through the procedure and give you reassurance to ensure your comfort!

Are there any risks or side effects?

When practiced by a trained provider, acupuncture is generally considered safe and low risk. However, as with any medical intervention, acupuncture treatments can produce side effects and even complications.

Minor side effects of acupuncture can include:

• Numbness and tingling following needle insertion
• Bleeding
• Nausea
• Skin bruising
• Needle site pain
• Dizziness

These side effects are rare, mild, and generally resolve quickly. Another risk of acupuncture is the transmission of infectious diseases (HIV and hepatitis). Your acupuncturist should use single-use, sterilized acupuncture pins (ask to see them open the package) one time only, even on you. Always work with a licensed acupuncturist to avoid risks like these.

Other serious but very rare side effects include:

• Nerve damage
• Increased pain
• Localized internal damage
• Injury to an internal organ

There are some people for whom acupuncture is not generally recommended. People with bleeding disorders or who those taking blood thinners (including daily aspirin) should discuss this with their acupuncturist before proceeding. Other people who should avoid acupuncture generally include:

• Those with serious psychiatric conditions such as psychosis
• Patients with breaks, burns, and infections in the skin
• People with hemophilia or other bleeding disorders

Electroacupuncture should not be performed near implanted electrical devices such as nerve stimulators and pacemakers. Pregnant women should avoid abdominal acupuncture.

How often should you have acupuncture for pain?

Every person’s treatment plan will be different. In general, expect to start seeing results after five to ten treatments. Most acupuncturists will recommend more frequent treatments during the acute phase of pain, tapering off into maintenance as the condition improves.