An Introduction to Evidence Based Acupuncture 

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“The word acupuncture meaning ‘to prick with a needle’ was coined by Willem ten Rhyne.”

“The word acupuncture meaning ‘to prick with a needle’ was coined by Willem ten Rhyne.”

What is Evidence Based Acupuncture?

The earliest detailed report on Chinese and Japanese medicine to be written by a European was by Willem ten Rhyne, a Dutch physician who published Dissertatio de arthritide in 1683 (Bivins 2001). 

Following this lineage, the concept of medical acupuncture was pioneered by Felix Mann who began to view acupuncture as a form of peripheral nerve stimulation technique. In this approach needles are inserted into anatomically defined sites, and stimulated manually or with electricity.

Preferential sites for acupuncture stimulation are associated with areas rich in specialized sensory receptors such as muscle spindles, Golgi tendon organs, ligament receptors, Paciniform and Ruffini’s receptors (joint capsules), deep pressure endings (within muscle belly), and free nerve endings (muscle and fascia). All of these areas are highly innervated and as a result there are a number of physiological responses that help modulate the experience of pain.

Acupuncture Research Has Matured

As research into acupuncture continues to mature, more clinical practice guidelines, randomized controlled trials and systematic reviews now support the use of acupuncture as part of a multidimensional approach for patients suffering from common musculoskeletal symptoms including:
• Chronic pain (MacPherson et al. 2017, Vickers et al. 2018)
• Acute pain (Cohen et al. 2017, Jan et al. 2017, Murakami et al. 2017, Sakamoto et al. 2018)
• Low back pain (Chou et al. 2017, Foster et al. 2018, Qaseem et al. 2017, Traeger et al. 2017)
• Neck pain (Blanpied et al. 2017, Chou et al. 2018, Kjaer et al. 2017)
• Pelvic pain (Franco et al. 2018)
• Tension-type headaches (Busse et al. 2017, Linde et al. 2016)
• Migraines (Busse et al. 2017, Linde et al. 2016, Yang et al. 2016)
• Osteoarthritis (Busse et al. 2017, Lin et al. 2016, Woods et al. 2017)
• Postoperative Pain (Tedesco et al. 2017) 
• Joint Pain Related to Aromatase Inhibitors (Hershman et al. 2018)

A Biopsychosocial Model: Many clinicians explain the mechanism of action in neurophysiological terms.

Evidence based acupuncture is an approach grounded in neuroscience that is based upon a theory that is inline current scientific understanding of how the body works. Using occam's razor the insertion of an acupuncture needle is a form of novel stimuli, that functions by sending anti-nociceptive input to the neuroimmune system. Stimulating endogenous opioid release, purinergic signaling and modulation of the endocannabinoid system.

Preferential sites for acupuncture stimulation are associated with areas rich in specialized sensory receptors such as muscle spindles, Golgi tendon organs, ligament receptors, Paciniform and Ruffini’s receptors (joint capsules), deep pressure endings (within muscle belly), and free nerve endings (muscle and fascia). 

Based off the biopsychosocial model, all of these areas are highly innervated and as a result there are a number of physiological responses that help modulate the experience of pain. An observed favorable outcome may be explained by a number of overlapping mechanism in the periphery, spinal cord, and brain including represented in the image below.

acupuncture - mechasism of action.png

More to Explore

Andronis et al. (2017). Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain: a Systematic Literature Review. Appl Health Econ Health Policy.
https://www.ncbi.nlm.nih.gov/pubmed/27550240

Bivins, R. (2001). The needle and the lancet: Acupuncture in Britain, 1683-2000. Acupuncture in Medicine.
https://www.ncbi.nlm.nih.gov/pubmed/11471579

Blanpied et al. (2017). Neck Pain: Revision 2017. J Orthop Sports Phys Ther
https://www.ncbi.nlm.nih.gov/pubmed/28666405

Busse et al. (2017). Guideline for opioid therapy and chronic noncancer pain. CMAJ.
https://www.ncbi.nlm.nih.gov/pubmed/28483845

Chen, L. & Michalsen, A. (2017). Management of chronic pain using complementary and integrative medicine. BMJ.
https://www.ncbi.nlm.nih.gov/pubmed/28438745

Cherkin, D.C. & Herman, P.M. (2018). Cognitive and Mind-Body Therapies for Chronic Low Back Pain and Neck Pain: Effectiveness and Value. JAMA Intern Med.
https://www.ncbi.nlm.nih.gov/pubmed/29507946

Chou et al. (2017). Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med.
https://www.ncbi.nlm.nih.gov/pubmed/28192793

Chou et al. (2018). The Global Spine Care Initiative: applying evidence-based guidelines on the non-invasive management of back and neck pain to low- and middle-income communities. Eur Spine J.
https://www.ncbi.nlm.nih.gov/pubmed/29460009/

Cohen et al. (2017). Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial. Med J Aust.
https://www.ncbi.nlm.nih.gov/pubmed/28918732/

Cummings et al. (2018). Should doctors recommend acupuncture for pain? BMJ.
https://www.ncbi.nlm.nih.gov/pubmed/29514785

Foster et al. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet.
https://www.ncbi.nlm.nih.gov/pubmed/29573872

Franco et al. (2018). Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database Syst Rev. 
https://www.ncbi.nlm.nih.gov/pubmed/29372565

Hershman et al. (2018). Effect of Acupuncture vs Sham Acupuncture or Waitlist Control on Joint Pain Related to Aromatase Inhibitors Among Women With Early-Stage Breast Cancer: A Randomized Clinical Trial. JAMA.
https://www.ncbi.nlm.nih.gov/pubmed/29998338

Jan et al. (2017). Review article: Does acupuncture have a role in providing analgesia in the emergency setting? A systematic review and meta-analysis. Emerg Med Australas.
https://www.ncbi.nlm.nih.gov/pubmed/28748654

Kim et al. (2018). Acupuncture Resolves Persistent Pain and Neuroinflammation in a Mouse Model of Chronic Overlapping Pain Conditions. J Pain.
https://www.ncbi.nlm.nih.gov/pubmed/29981376

Kjaer et al. (2017). National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy. Eur Spine J.
https://www.ncbi.nlm.nih.gov/pubmed/28523381

Lin et al. (2016). The Effects of Acupuncture on Chronic Knee Pain Due to Osteoarthritis: A Meta-Analysis. The Journal of Bone & Joint Surgery.
https://www.ncbi.nlm.nih.gov/pubmed/27655986

Linde et al. (2016). Acupuncture for the prevention of tension-type headache. Cochrane Database of Systematic Reviews.
https://www.ncbi.nlm.nih.gov/pubmed/27092807

Linde et al. (2016). Acupuncture for the prevention of episodic migraine. Cochrane Database of Systematic Reviews.
https://www.ncbi.nlm.nih.gov/pubmed/27351677

Lorenc et al. (2018). Scoping review of systematic reviews of complementary medicine for musculoskeletal and mental health conditions. BMJ Open.
https://www.ncbi.nlm.nih.gov/pubmed/30327397

MacPherson et al. (2017). Acupuncture for chronic pain and depression in primary care: a programme of research. Southampton (UK): NIHR Journals Library.
https://www.ncbi.nlm.nih.gov/pubmed/28121095

Millstine et al. (2017). Complementary and integrative medicine in the management of headache. BMJ.
https://www.ncbi.nlm.nih.gov/pubmed/28512119

Murakami et al. (2017). Ear Acupuncture for Immediate Pain Relief-A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain Med.
https://www.ncbi.nlm.nih.gov/pubmed/28395101

Qaseem et al. (2017). Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med.
https://www.ncbi.nlm.nih.gov/pubmed/28192789

Sakamoto et al. (2018). Are non-pharmacologic pain interventions effective at reducing pain in adult patients visiting the Emergency Department? A Systematic Review and Meta-analysis. Acad Emerg Med.
https://www.ncbi.nlm.nih.gov/pubmed/29543359/

Tedesco et al. (2017). Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty: A Systematic Review and Meta-analysis. JAMA Surg.
https://www.ncbi.nlm.nih.gov/pubmed/28813550

Traeger et al. (2017). Diagnosis and management of low-back pain in primary care. CMAJ.
https://www.ncbi.nlm.nih.gov/pubmed/29133540

Vickers et al. (2018). Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. The Journal of Pain.
https://www.ncbi.nlm.nih.gov/pubmed/29198932

Wenger, H.C., Cifu, A.S. (2017). Treatment of Low Back Pain. JAMA.
https://www.ncbi.nlm.nih.gov/pubmed/28829855

Woods et al. (2017). Cost-effectiveness of adjunct non-pharmacological interventions for osteoarthritis of the knee. PLoS One.
https://www.ncbi.nlm.nih.gov/pubmed/28267751

Yang et al. (2016). Verum versus sham manual acupuncture for migraine: a systematic review of randomised controlled trials. Acupunct Med.
https://www.ncbi.nlm.nih.gov/pubmed/2671800  

Zhao et al. (2017). The Long-term Effect of Acupuncture for Migraine Prophylaxis A Randomized Clinical Trial. JAMA Intern Med.
https://www.ncbi.nlm.nih.gov/pubmed/28241154