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Pinning down acupuncture's role in medicine. (Several Studies Show Benefits).

SAN DIEGO -- The ancient practice of acupuncture could be ready to enter mainstream medicine.

Acupuncture may have a role in treating many complaints common in some medical practices, such as musculoskeletal pain or some gastrointestinal disorders, Dr. Robert Bonakdar said at the annual meeting of the American Academy of Family Physicians.

Evidence that acupuncture does, in fact, produce a physiologic response can be found in studies of its effect on neurotransmitters and opiate receptors, said Dr. Bonakdar of the Scripps Center for Integrative Medicine in La Jolla, Calif.

In a randomized, controlled, double-blinded study of 40 patients, auricular electroacupuncture produced an 18% increase in pain threshold, a statistically significant change, while pain thresholds remained nearly unchanged in control patients.

However, when the acupuncture was followed by a dose of naloxone, which blocks opiate receptors, the pain threshold rose by only 12%, leading the authors to conclude that the effects of acupuncture are mediated in part by endogenous opiates (Anesth. Prog. 40[1]:14-19, 1993).

In another study, electroacupuncture was used in 32 Swedish patients with osteoarthritis, whose pain was separated into affective (unpleasantness) and sensory (intensity) components. The investigators found that pain alleviation was more significant on the affective (P<0.0l) than on the sensory (P<0.05) component of pain. Pain relief was diminished when the patients took diazepam or naloxone before undergoing electroacupuncture (Am. J. Chin. Med. 19[l]:1-7, 1991). Other studies have shown that endorphin antibodies or genetic defects in opiate receptors also block acupuncture analgesia.

Depending on the patient's complaint, acupuncture treatments may last 5-60 minutes, but a typical session is 30-40 minutes. Typically, a patient will have from one to three treatments a week for 4-8 weeks, then weekly follow-up sessions for 1-3 months. The greatest effects are usually seen early in therapy, with some studies showing patients retaining 80% of the benefit 6 months after 4-8 weeks of treatment. Patients with long-standing pain usually have a lower success rate than those treated earlier because their pathology is more entrenched, Dr. Bonakdar said.

Major complications associated with acupuncture are rare but serious and include pneumothorax, infection, and spinal cord injury. Relative contraindications include pregnancy or severe bleeding and immune system disorders. Patients with cardiac arrhythmias or pacemakers should discuss this with their doctor and be cautious regarding electroacupuncture. An unclear diagnosis is also a relative contraindication, he said.

Doctors interested in incorporating acupuncture into their practices have the option of becoming advisers who discuss the indications, risks, and benefits with patients and provide referrals. Those wishing to become physician acupuncturists should check the laws in their states because they vary. Some states consider acupuncture within the realm of standard medical practice and therefore require no additional training of physicians. Other states require several hundred hours of specialized training, usually through a course approved by the American Academy of Medical Acupuncture, www.medicalacupuncture.org. Dr. Bonakdar recommended this approach even if it is not required by the state.

Liability coverage also varies by state. Some carriers consider acupuncture within the scope of normal medical practice, while others require additional waivers, he said.

RELATED ARTICLE: Unlocking the chi

To learn more about acupuncture, Chinese medicine, and state requirements for including acupuncture in their practices, Dr. Bonakdar recommended the following Web sites:

* www.medicalacupuncture.org, the Web site of the American Academy of Medical Acupuncture.

* www.acupuncture.com has information on acupuncture and traditional Chinese medicine, with sections for professionals and lay readers. The Web site also includes a list of state laws governing acupuncture practice.

* http://odp.od.nih.gov/consensus/cons/107/107_intro.htm, a Web site sponsored by the National Institutes of Health, contains the 1997 NIH consensus conference on acupuncture.

* http://websites.golden-orb.com/paineducation/100196.php contains a list of useful Web sites on acupuncture and traditional Chinese medicine.
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Author:MacReady, Norra
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Mar 1, 2003
Words:639
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