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.
More to Explore
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Bivins, R. (2001). The needle and the lancet: Acupuncture in Britain, 1683-2000. Acupuncture in Medicine.
Blanpied, P.R., Gross, A.R., ... Robertson, E.K. (2017). Neck Pain: Revision 2017. J Orthop Sports Phys Ther
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Franco, J.V., Turk, T., ... Vietto, V. (2018). Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database Syst Rev.
Hershman, D.L., Unger, J.M., Greenlee, H., ... Crew, K.D. (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.
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