An Introduction to Evidence Based Acupuncture 

 “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. 2017Vickers et al. 2018)
• Acute pain (Cohen et al. 2017Jan et al. 2017Murakami 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. 2017Chou et al. 2018Kjaer et al. 2017)
• Pelvic pain (Franco et al. 2018)
• Tension-type headaches (Busse et al. 2017Linde et al. 2016)
• Migraines (Busse et al. 2017Linde et al. 2016Yang et al. 2016)
• Osteoarthritis (Busse et al. 2017Lin et al. 2016Woods et al. 2017)
• Postoperative Pain (Tedesco et al. 2017

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 L, Kinghorn P, Qiao S, Whitehurst DG, Durrell S, McLeod H. (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, P.R., Gross, A.R., Elliott, J.M., Devaney, L.L., Clewley, D., Walton, D.M., Sparks, C., Robertson, E.K. (2017). Neck Pain: Revision 2017. J Orthop Sports Phys Ther
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Busse, J.W., Craigie, S., Juurlink, D.N, ... Guyatt GH. (2017). Guideline for opioid therapy and chronic noncancer pain. CMAJ.
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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.
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Chou, R., Deyo, R., Friedly, J., Skelly, A., Hashimoto, R., ... Brodt, E.D. (2017). Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med.
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Chou, R., Côté, P., ... Cedraschi, C. (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/

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https://www.ncbi.nlm.nih.gov/pubmed/28918732/

Cummings, M., Hróbjartsson, A., Ernst, E. (2018). Should doctors recommend acupuncture for pain? BMJ.
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Foster, N.E., Anema, J.R., Cherkin, D., ... Maher, C.G. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet.
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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. 
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Jan, A.L., Aldridge, E.S., Rogers, I.R., Visser, E.J., Bulsara, M.K., Niemtzow, R.C. (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

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Lin, X., Huang, K., Zhu, G., Huang, Z., Qin, A., & Fan, S. (2016). The Effects of Acupuncture on Chronic Knee Pain Due to Osteoarthritis: A Meta-Analysis. The Journal of Bone & Joint Surgery.
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Linde, K., Allais, G., Brinkhaus, B., Fei, Y., Mehring, M., Shin, B., . . . White, A. R. (2016). Acupuncture for the prevention of tension-type headache. Cochrane Database of Systematic Reviews.
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Linde, K., Allais, G., Brinkhaus, B., Fei, Y., Mehring, M., Vertosick, E. A., . . . White, A. R. (2016). Acupuncture for the prevention of episodic migraine. Cochrane Database of Systematic Reviews.
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MacPherson, H., Vickers, A., Bland, M., Torgerson, D., Corbett, M., Spackman, E., ..., Watt, I. (2017). Acupuncture for chronic pain and depression in primary care: a programme of research. Southampton (UK): NIHR Journals Library.
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Murakami, M., Fox, L., Dijkers, M.P. (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, A., Wilt, T.J., McLean, R.M., Forciea, M.A. (2017). Clinical Guidelines Committee of the American College of Physicians.. 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, J.T., Ward, H.B., Vissoci, J.R.N., Eucker, S.A. (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, D., Gori, D., Hernandez-Boussard, T. (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, A., Buchbinder, R., Harris, I., Maher, C. (2017). Diagnosis and management of low-back pain in primary care. CMAJ.
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Vickers, A.J., Vertosick, E.A., Lewith, G., ... Linde, K. (2018). Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. The Journal of Pain.
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Woods, B., Manca, A., ... Sculpher, M. (2017). Cost-effectiveness of adjunct non-pharmacological interventions for osteoarthritis of the knee. PLoS One.
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Yang, Y., Que, Q., Ye, X., Zheng, G.h. (2016). Verum versus sham manual acupuncture for migraine: a systematic review of randomised controlled trials. Acupunct Med.
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Zhao, L., Chen, J., ... Liang, F. (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