by William Alexander | Apr 4, 2017 | About Acupuncture, Health Benefits of Acupuncture
Why Doctors Approve Acupuncture For Medical Ailments Treatment
The American College of Physicians formally recommends acupuncture for the treatment of back pain. Published in the prestigious Annals of Internal Medicine, clinical guidelines were developed by the American College of Physicians (ACP) to present recommendations based on evidence. Citing quality evidence in modern research, the ACP notes that nonpharmacologic treatment with acupuncture for the treatment of chronic low back pain is recommended. The official grade by the ACP is a “strong recommendation.” 
The Medical Goal of Acupuncture
A major goal of the recommendation is for acupuncture and other nonpharmacological therapies to replace drug therapy as a primary source of pain relief. Treatment with opioids is only recommended, with an official “weak recommendation,” when other modalities do not provide adequate relief. A strong recommendation is also made by the American College of Physicians for the treatment of both acute and subacute lower back pain with heat, massage, acupuncture, and spinal manipulation.  The recommendations were approved by the ACP Board of Regents and involves evidence based recommendations from doctors at the Penn Health System (Philadelphia, Pennsylvania), Minneapolis Veterans Affairs Medical Center (Minnesota), and the Yale School of Medicine (New Haven, Connecticut).
The American College of Physicians notes that approximately 25% of USA adults have had, at the very minimum, a one day lower back pain episode within the past three months. The socioeconomic impact of lower back pain in the USA was approximately $100 billion in the year 2006 . The costs include medical care and indirect costs due to lost wages and declines in productivity.  Recommendations for treatment options, including those for the use of acupuncture, include considerations of positive medical patient outcomes, the total number of back pain episodes, duration between episodes, alleviation of lower back pain, improvement in function of the back, and work disability reductions. Recommendations are for both radicular and nonradicular lower back pain.
The target audience for the American College of Physicians recommendations includes all doctors, other clinicians, and the adult population with lower back pain. The ACP notes, “Moderate-quality evidence showed that acupuncture was associated with moderately lower pain intensity and improved function compared with no acupuncture at the end of treatment .”  In agreement, the National Institute of Neurological Disorders and Stroke (National Institutes of Health) notes that acupuncture is an effective treatment modality for the relief of chronic lower back pain. 
These findings are consistent with those published in Mayo Clinic proceedings finding that acupuncture is effective for the treatment of lower back pain. The same Mayo Clinic report notes that acupuncture does not cause any significant adverse effects.  The Mayo Clinic findings apply to both nociceptive and non-nociceptive pain. Nociceptive back pain includes musculoskeletal inflammation and pain involving nerve cells wherein nociceptors are activated. Nociceptors are afferent neurons in the skin, muscles, joints, and other areas. For example, nerve impingement (often referred to as a “pinched nerve”) produces one type of nociceptive pain.
Non-nociceptive pain does not involve inflammation and is more relevant to pain processing in the central nervous system. One type of non-nociceptive pain condition is fibromyalgia and acupuncture has been confirmed as an effective treatment modality for this condition. The Mayo Clinic proceedings note, “Martin et al. found a significant improvement between electroacupuncture vs sham electroacupuncture. Differences were seen on the Fibromyalgia Impact Questionnaire (FIQ) scores for fatigue and anxiety.” 
The Mayo Clinic and American College of Physicians findings are consistent with additional quality research. Memorial Sloan Kettering Cancer Center (New York) and University of York (United Kingdom) researchers note “We have provided the most robust evidence from high-quality trials on acupuncture for chronic pain. The synthesis of high-quality IPD found that acupuncture was more effective than both usual care and sham acupuncture. Acupuncture is one of the more clinically effective physical therapies for osteoarthritis and is also cost-effective if only high-quality trials are analysed.” 
Doctors understand the true need for effective pain management. Nonpharmacological solutions are important for a variety of reasons including prevention of addiction, effective relief of pain, and prevention of adverse effects. This is often of heightened concern during pregnancy and for children. As a result, university hospitals integrate acupuncture into usual care settings to improve patient outcomes. For example, pediatric doctors at the UCSF Benioff Children’s Hospital San Francisco provide acupuncture to children, including non-needle laser acupuncture. At the University of California hospital, acupuncture is made available for both inpatients and outpatients. Dr. Kim notes that acupuncture reduces nausea up to 70%. She adds that acupuncture is also effective for significant reductions in post-surgical pain and chronic headaches. 
Recently, researchers have discovered how acupuncture stops pain and provides other forms of relief for patients. Breakthrough research conducted by University of South Florida (Tampa) and Fujian University of Traditional Chinese Medicine (Fuzhou) researchers documents how acupuncture stops pain. The researchers note, “acupuncture exerts a remarkable analgesic effect on SCI [spinal cord injury] by also inhibiting production of microglial cells through attenuation of p38MAPK and ERK activation.” 
Microglia are central nervous system immunity cells that secrete proinflammatory and neurotoxic mediators. Acupuncture reduces pain by attenuating this response. The researchers also document that acupuncture provides neuroprotection. The researchers note that acupuncture prevents brain damage in the hippocampus by “preventing microglial activation.” The University of South Florida members of the research team were from the Department of Neurosurgery and Brain Repair and the Department of Pharmaceutical Sciences. Funding was provided by the United States Department of Defense, University of South Florida Neurosurgery and Brain Repair, and the James and Esther King Biomedical Research Foundation.
The aforementioned research reveals an important biochemical mechanism involved in acupuncture’s ability to alleviate pain and reduce harmful inflammation. Researchers focus on other mechanisms activated by administration of acupuncture treatments. For example, laboratory investigations reveal how acupuncture regulates blood pressure.
University of California (Irvine) researchers find acupuncture effective for the treatment of high blood pressure. In a controlled laboratory study, University of California researchers have proven that electroacupuncture at acupoint ST36 (Zusanli) promotes enkephalin production, which dampens proinflammatory excitatory responses from the sympathetic nervous system that cause hypertension. Specifically, electroacupuncture regulates preproenkephalin gene expression, a precursor substance that encodes proenkephalin, which then stimulates the production of enkephalin. 
The formal recommendation for the use of acupuncture in cases of lower back pain by the American College of Physicians is based on modern research. Mayo Clinic findings and research from the Memorial Sloan Kettering Cancer Center (New York) and the University of York support this recommendation. In response to the needs of patients, doctors have already implemented acupuncture into several hospitals throughout the USA and both inpatient and outpatient acupuncture treatments are available.
Now, modern scientific investigations reveal how acupuncture works. University of South Florida and Fujian University of Traditional Chinese Medicine researchers confirm acupuncture’s ability to attenuate microglial activation. University of California researchers have quantified acupuncture’s ability to control inflammation by regulating enkephalins. In addition, the NCCAOM (National Certification Commission for Acupuncture and Oriental Medicine) provides professional certification for acupuncturists, which ensures standards of excellence for licensed acupuncturists. Given the large body of supportive research and the administrative support for providing safe and effective acupuncture to the general public, expect to see greater implementation of acupuncture into usual care settings.
Contact Affinity Acupuncture today for Nashville Acupuncture treatments and appointments!
1. Qaseem, Amir, Timothy J. Wilt, Robert M. McLean, and Mary Ann Forciea. “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of PhysiciansNoninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain.” Annals of Internal Medicine (2017).
2. Qaseem, et al. Annals of Internal Medicine (2017).
3. Katz J.N. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences.J Bone Joint Surg Am200688 Suppl 2214.
4. Lam M. Galvin R. Curry P. Effectiveness of acupuncture for nonspecific chronic low back pain: a systematic review and meta-analysis.Spine (Philadelphia, Pennsylvania 1976) 201338212438.
5. ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet. Low Back Pain Fact Sheet, National Institute of Neurological Disorders and Stroke, National Institutes of Health.
6. Nahin, Richard L., Robin Boineau, Partap S. Khalsa, Barbara J. Stussman, and Wendy J. Weber. “Evidence-based evaluation of complementary health approaches for pain management in the United States.” In Mayo Clinic Proceedings, vol. 91, no. 9, pp. 1292-1306. Elsevier, 2016.
7. Martin DP, Sletten CD, Williams BA, Berger IH. Improvement
in fibromyalgia symptoms with acupuncture: results of a randomized
controlled trial. Mayo Clin Proc. 2006;81(6):749-757.
8. MacPherson, H., A. Vickers, M. Bland, D. Torgerson, M. Corbett, E. Spackman, P. Saramago et al. “Acupuncture for chronic pain and depression in primary care: a programme of research.” (2017).
9. Leslie Lingaas. ucsf.edu/news/2014/04/113966/acupuncture-helps-young-patients-manage-pain. Acupuncture Helps Pediatric Patients Manage Pain and Nausea, 2014.
10. Lin, Lili, Nikola Skakavac, Xiaoyang Lin, Dong Lin, Mia C. Borlongan, Cesar V. Borlongan, and Chuanhai Cao. “Acupuncture-induced analgesia: the role of microglial inhibition.” Cell transplantation 25, no. 4 (2016): 621-628.
11. Cevic, C and Iseri, SO. The effect of acupuncture on high blood pressure of patients using antihypertensive drugs. Acupuncture & electro-therapeutics research 2013; 38(1-2): 1-15. ncbi.nlm.nih.gov/pubmed/23724695.
by William Alexander | Dec 7, 2016 | Acupuncture Nashville TN, Back Pain
Qi-guiding acupuncture relieves disc herniation pain and a special intensive silver acupuncture needle protocol relieves chronic lower back myofascial pain.
Researchers find acupuncture effective for the treatment of lower back pain disorders. In a protocolized study from the Shanghai Jiaotong University Sixth People’s Hospital, researchers determined that a special type of manual acupuncture therapy, known as qi-guiding acupuncture, produces significant positive patient outcomes for lumbar intervertebral disc herniation patients. In related research from Xinping Hospital of Traditional Chinese Medicine, investigators find acupuncture combined with moxibustion effective for the alleviation of lower back pain due to lumbodorsal myofascial pain syndrome. A special application of silver acupuncture needles produced superior patient outcomes. Let’s start with a look at the Shanghai Jiaotang University research and then we’ll see how the silver needle protocol boosts treatment efficacy for the treatment of lower back pain.
Acupuncture is effective for the treatment of lumbar intervertebral disc herniations. Wu et al. (Shanghai Jiaotong University Sixth People’s Hospital) investigated the treatment results of qi-guiding acupuncture with meridian differentiated acupoint selections and determined that it produces significant positive treatment outcomes for lumbar intervertebral disc herniation patients. Wu et al. also find electroacupuncture with meridian differentiated acupoint selections effective; however, qi-guiding acupuncture had a slightly higher rate of producing positive patient outcomes. Qi-guiding acupuncture had an 87.5% total treatment effective rate and electroacupuncture achieved an 86.6% total treatment effective rate. Qi-guiding acupuncture also had better outcomes for increases in nerve conduction velocity. The results are definitive given the large sample size of 549 patients with lumbar disc herniations evaluated in this study.
Lumbar disc herniation patients experience lower back pain and radiculopathy (radiating pain and numbness) as a result of anulus fibrosis damage, IVF encroachment, and other issues associated with disc damage (Hu et al.). Acupuncture, as one of the most common non-surgical treatment methods for lumbar disc herniation, has a high treatment effective rate and no significant adverse effects (Cheng).
Qi-guiding acupuncture was first documented in ancient literature, including The Systematic Classic of Acupuncture & Moxibustion by Huang-fu Mi. In qi-guiding acupuncture, needle entry and removal is controlled and slow. To direct qi upward, the acupuncture needle is oriented upward; similarly, to direct qi downward, the needle is pointed downward. Subsequently, the needle is frequently rotated, lifted, and thrust to regulate the flow of qi in the body. Additional manipulation techniques may be intermittently applied. In modern use, qi-guiding acupuncture repairs ultramicroscopic structures of damaged nerve roots and accelerates other aspects of nerve repair, thereby increasing nerve conduction.
In this study, lumbar disc herniation patients receiving qi-guiding acupuncture achieved an 87.5% total treatment effective rate. Patients receiving electroacupuncture achieved an 86.6% total treatment effective rate. Both qi-guiding acupuncture and electroacupuncture significantly increased nerve conduction velocity. Qi-guiding acupuncture had a slightly greater improvement in common peroneal nerve conduction velocity and superficial fibular nerve conduction velocity. Common peroneal nerve conduction velocity increased from 38.26 ± 12.8 to 44.75 ± 5.24 after the application of qi-guiding acupuncture, and increased from 39.11 ± 3.64 to 39.86 ± 10.95 after electroacupuncture. Superficial fibular nerve conduction velocity increased from 41.63 ± 4.37 to 42.55 ± 6.43 after the application of qi-guiding acupuncture, and increased from 40.71 ± 9.56 to 40.43 ± 4.01 after electroacupuncture.
A total of 549 patients with lumbar disc herniations were treated and evaluated in this study. These patients were diagnosed with lumbar disc herniations between December 2012 and March 2014. They were randomly divided into a treatment group and a control group, with 280 patients in the treatment group and 269 patients in the control group. The treatment group underwent qi-guiding acupuncture therapy, while the control group received electroacupuncture. Acupoint selection for both groups was based on meridian differentiation. Identical acupoints were selected for both patient groups.
For Taiyang meridian lumbago and leg pain (scelalgia):
For Yangming meridian lumbago and leg pain:
For Shaoyang meridian lumbago and leg pain:
For qi-guiding acupuncture, the following protocol was administered. Upon disinfection with 75% ethanol, a 0.30 mm x 40 mm filiform acupuncture needle was inserted into each selected acupoint. Huantiao and Juliao were needle to a depth of 2.5 inches. The remaining acupoints were needled to a depth of 1.2 inches. When a deqi sensation was achieved for all acupoints, qi-guiding needling with the Xie (reducing) manipulation technique was applied to Weizhong, Tiaokou, and Yanglingquan to transmit the needling sensation upward and toward the hip or waist. The same technique was applied to Huantiao, Juliao, and Biguan, instead transmitting the needle sensation downward and toward the legs. Subsequently, qi-guiding needling with the Bu (tonification) manipulation technique was applied on Dachangshu to transmit the needle sensation toward the lumbosacral area. The same technique was used on Shenshu until a deqi sensation of soreness or swelling was perceived at the lumbar region. A needle retention time of 20 minutes was observed during which the needles were rotated, lifted, and thrusted every 5 minutes to facilitate the flow of qi. One qi-guiding acupuncture session was conducted every other day for a total of 10 treatments.
Electroacupuncture for the control group was administered with the same aforementioned protocol. Before needle retention, the needles were connected to an electroacupuncture device. The device was then set to a continuous wave at 4 Hz with a 2mA current. A 20 minute needle retention time was subsequently observed. One electroacupuncture session was conducted every other day for a total of 10 treatments. The clinical results the Wu et al. study demonstrate that both qi-guiding acupuncture and electroacupuncture, when combined with meridian-differentiated acupoint selection, are suitable and effective therapies for lumbar disc herniation patients. However, qi-guiding acupuncture produces slightly better treatment outcomes in terms of nerve conduction velocity improvements.
In a related study, Wang H.D. (Xinping Hospital of Traditional Chinese Medicine) finds acupuncture combined with moxibustion therapy effective for the treatment of lumbodorsal myofascial pain syndrome. The study also finds that a silver needle protocol produces preferable treatment outcomes to conventional acupuncture. Lumbodorsal myofascial pain syndrome causes chronic lumbago and commonly occurs in young adults. Intensive acupuncture combined with moxibustion using silver needles was famously used by Professor Xuan Zhe Ren, a renowned Chinese orthopedist.
Acupoints were selected based on the degree of soft tissue damage, area of muscular tissue involved, and size of tendon contracture. In this approach, acupoints are 2 cm apart from each other and are mainly located on the lumbosacral region. Results from Wang’s study demonstrate that lumbodorsal myofascial pain syndrome patients receiving intensive acupuncture combined with moxibustion using silver needles achieved a 90% total treatment effective rate. Conventional acupuncture with moxibustion achieved an 83.3% total treatment effective rate.
Wang’s study involved a total of 60 patients with lumbodorsal myofascial pain syndrome. They were divided into a treatment group and a control group, with 30 patients in each group. The treatment group underwent intensive acupuncture-moxibustion therapy with silver needles. The control group received conventional acupuncture-moxibustion.
Intensive acupuncture-moxibustion with silver needles was applied to the T12 – L4 Jiaji acupoints and the acupoints located at the midpoint between each Jiaji acupoint. In addition, acupoints located 2 cm lateral to the Jiaji acupoints were needled. Finally, moxibustion applied with one Zhuang of 3 cm moxa cigar. One session was conducted daily for a total of 7 days. For conventional acupuncture-moxibustion therapy, the following primary acupoints were selected:
Additional acupoints were selected based on individual symptoms. For lumbago with chill-dampness:
For lumbago due to exhaustion:
For lumbago with kidney deficiency:
A needle retention time of 30 minutes was observed. Subsequently, moxibustion was applied using either a 4 hole or 6 hole moxa box on the lumbar acupoints. One session was conducted daily for a total of 7 days. The treatment efficacy for each patient was evaluated and categorized into 1 of 3 tiers:
Recovery: Complete elimination of symptoms. Physical movement regained completely. No pain points.
Significantly effective: Elimination of symptoms. Physical movement regained. Discomfort reoccurs only under exhaustion or change in weather. No pain or numbness.
Effective: Symptoms relieved. Pain or numbness present.
Not effective: No improvement in symptoms.
The total treatment effective rate for each patient group was derived as the percentage of patients who achieved at least an effective tier of improvement. The intensive acupuncture-moxibustion with silver needles protocol outperformed conventional acupuncture. However, both approaches produced significant positive patient outcomes.
Both aforementioned studies indicate that acupuncture is effective for the alleviation of lower back pain. These studies highlight the differences in therapeutic effects between various forms of acupuncture. As a result, qi-guiding acupuncture and intensive acupuncture-moxibustion with silver needles are found clinically effective for the relief of lower back pain.
Wu YC, Sun YJ, Zhang JF, Li Y, Zhang YY & Wang CM. (2014). Clinical Study of Qi-guiding Acupuncture at Points Selected According to Meridian Differentiation for Treatment of Lumbar Intervertebral Disc Herniation. Shanghai Journal of Acupuncture and Moxibustion. 33(12).
Cheng XN. (1987). The study of Chinese acupuncture-moxibustion. Volume 1, Beijing: People’s medical publishing house. 192-284.
Hu YG. (1995). Prolapse of lumbar intervertebral disc. Volume 2, Beijing: People’s medical publishing house. 226-228.
Zhu WM, Wu YC, Zhang JF, et al. (2010). Tuina combined with acupoint injection in treating prolapse of lumbar intervertebral disc. Chinese Journal of Sports Medicine. 29(6): 708-709.
Wang HD. (2013). Clinical Observation on Intensive Acupuncture-moxibustion with Silver Needles for Lumbodorsal Myofascial Pain Syndrome. Shanghai J Acu-mox. 32(8).