Acupuncture
and Arthritis (By Judith Hortsman)
Getting stuck with needles sounds more like torture than a medical
treatment. But there's evidence that acupuncture – a standard
health practice in asia – helps relieve pain. Should you
try it for arthritis?
The Chinese therapy of acupuncture has been used for millennia
to treat a range of ailments. Now it looks like Western medicine
is getting the point.
Acupuncture has become one of the most popular – and accepted
– unconventional therapies within the United States.
It's offered in many chronic pain clinics, and is covered by
some insurers and managed heath organizations. The World Health
Organization recommends it for more than 40 conditions as diverse
as asthma and chronic pain. The Food and Drug Administration
regulates acupuncture needles as medical devices, the same as
it does surgical tools. And in 1997, a National Institutes of
Health panel found acupuncture to be an acceptable treatment
for many pain conditions, including fibromyalgia and general
musculoskeletal pain. And, no, it usually doesn't hurt after
an initial "pinch" or sting. So it's no surprise that
some rheumatologists are suggesting acupuncture, along with
more conventional treatments, to their arthritis patients –
and a few even give acupuncture treatments themselves.
"It's really almost mainstream now," says Stuart
S. Kassan, MD, a rheumatologist in private practice in Denver
who became an acupuncturist in 1996. "It's safe when done
properly, and can be very helpful for pain."
However, Dr. Kassan says, many doctors do remain skeptical.
"Some roll their eyes and say they can't believe I'm doing
acupuncture," he says. "But rheumatologists see a
lot of patients with problems we can't do anything about, especially
chronic pain. We all become very frustrated. And this is where
acupuncture makes its greatest impact: with patients who have
failed conventional treatment."
Don L. Goldenberg, MD, chief of rheumatology at Newton-Wellesley
Hospital and professor of medicine at Tufts University School
of Medicine in Boston, agrees. A fibromyalgia specialist, he
often works in conjuction with a medical doctor trained in acupuncture,
which he finds often gives good results when used in addition
to more conventional treatments. "Acupuncture clearly can
help lots of chronic pain issues, including fibromyalgia,"
he says.
But it doesn't work for everyone. "Some people respond
spectacularly – but not all," says Wendell Hatfield,
MD, a Denver rheumatologist who is also a trained acupuncturist.
"And as with all treatments for chronic conditions, it's
not a cure. It helps control the symptoms."
• WHAT IS ACUPUNCTURE?
Acupuncture
is the use of fine needles inserted into the skin at precise
points. It originated in China thousands of years ago, and is
based on the theory that an essential life energy called qi
(pronounced chee) flows through the body along invisible channels,
called meridians. When the flow of qi is blocked or out of balance,
illness or pain results. Stimulation of specific points along
the meridians can correct the flow of qi to restore or optimize
health, or to block pain, according to Chinese theory.
The "acupoints" can also be stimulated with heated
herbs (called moxibustion), magnets, mild electrical current
(electroacupuncture), manual pressure (acupressure), low-frequency
lasers, or even bee stings. A traditional Chinese medicine practitioner
may also offer herbs along with lifestyle advice. (See "What
Happens in an Acupuncture Treatment").
Western scientists don't know exactly how acupuncture works.
However, some acupoints correspond to areas, called trigger
points, that are known to be rich in nerve endings, and studies
show stimulating acupoints causes multiple biologic responses.
Such stimulation can prompt a cascade of chemicals in the muscles,
spinal cord and brain that releases the body's natural pain-killing
endorphins, and can also affect circulation and other bodily
systems.
• WHAT THE RESEARCH
SHOWS
Acupuncture
has been described in thousands of writings throughout the centuries.
Among the many recent studies are several that show it relieves
osteoarthritis symptoms – so well in one Scandinavian study
that 25 percent of patients previously scheduled for knee surgery
canceled their plans. That same study showed booster treatments
once a month sustained the pain relief.
Other studies have shown that acupuncture helps relieve pain
from fibromyalgia and osteoarthritis; can decrease the number
and severity of Raynaud's phenomenon attacks; helps ease conditions
that can accompany arthritis such as depression and irritable
bowel syndrome; and enhance conventional treatments for gout,
when used in a combined therapy.
However, a 1997 meta-analysis of 17 studies that looked at acupuncture
in inflammatory diseases such as rheumatoid arthritis, spondylarthropathy,
lupus and local and progressive systemic scleroderma found the
studies failed to show the effectiveness of acupuncture for
these conditions.
Furthermore, many studies are not published in English and few
acupuncture studies meet rigorous scientific standards. A 1999
analysis of studies that looked at acupuncture for fibromyalgia,
for example, found seven that suggested it relieves pain, reduces
morning stiffness and may improve sleep, but only one of those
studies was considered to meet high scientific standards, says
Brian Berman, MD, director of the Complementary Medicine Program
(CMP) at the University of Maryland in Baltimore.
Dr. Berman, who also practices acupuncture, says more and better
studies are needed to measure the effects of acupuncture. The
CMP has three NIH-funded studies underway looking at acupuncture
and both osteoarthritis and post-operative pain.
• WHAT THE EXPERTS
SAY
There's
enough research to suggest acupuncture relieves pain for some,
and that it is safe when performed by a trained professional
using sterile or disposable needles.
Acupuncture appears to work best on fibromyalgia and soft-tissue
pain, and to be least effective for rheumatoid arthritis or
other systemic inflammatory conditions, doctors say. Relief
is often temporary, and treatments can be time-consuming and
expensive.
"If asked, I encourage patients to try it and make up their
own minds as to its usefulness," says Robert Bennett, MD,
professor of medicine and chairman of the division of arthritis
and rheumatic diseases at Oregon Health Sciences Center in Portland.
"A few patients will integrate it into their treatment,
but most patients give up acupuncture because it's so costly,
both in dollars and time, to have two or three sessions a week."
Acupuncture may not be covered by your insurance, even if it's
given by a medical doctor. Costs vary across the country, but
generally a first visit runs $75 to $150, with follow-up visits
between $35 and $75. At these rates – for weekly or more
often sessions – some rheumatologists say acupuncture isn't
cost-effective.
Acupuncture advocates disagree. In the beginning, acupuncture's
pain-relieving effects may last a week or less, Dr. Kassan admits.
"But after four or five weekly treatments, many patients
find they can progressively decrease the frequency and end up
with monthly treatments. It may also decrease the need for pain
medications."
Other advocates believe acupuncture's effects may go beyond
temporary pain relief. "Acupuncture is a stimulus that
can help repattern the body and help break the chronic pain
syndrome," says Ka-Kit Hui, MD, an internist and clinical
pharmacologist who is director of the integrated Center for
East-West Medicine at the University of California, Los Angeles.
It can also stimulate circulation and people can be taught acupressure
massage to help themselves, he says.
One thing experts concur on is that acupuncture won't cure arthritis.
"Acupuncture doesn't replace conventional medicine,"
says Dr. Hatfield. "But it adds another dimension beyond
what we have now."
• GOOD ADVICE
Acupuncture
is generally safe, but as with any therapy – conventional
or alternative – you should observe some precautions.
Choose
a therapist who is licensed and/or a graduate of a respected
school of acupuncture, and who is willing to work with your
doctor. Some 10,000 acupuncturists currently practice in the
United States and most are regulated by the state in which they
reside. About 4,000 doctors have completed a recognized acupuncture
training program (see "Resources" below).
Get
a diagnosis from a medical doctor before undergoing acupuncture,
to make sure you don't have a condition requiring prompt medical
attention.
Don't
stop your medications without consulting your doctor. Acupuncture
works with, not instead of, conventional medicine.
Tell
the acupuncturist about all health conditions, including
pregnancy; and list all medications (including herbs and non-steroidal
anti-inflammatory drugs that could cause you to bleed, for example).
Be sure
the acupuncturist uses sterilized or disposable needles.
Don't
take muscle relaxants, tranquilizers or painkillers right
before acupuncture, as acupuncture may intensify the effects
of these drugs.
Tell
the practitioner right away if you experience pain or bleeding.
Acupuncture
shouldn't hurt after the initial sting of the needle's
insertion; you should not bleed more than a few drops.
Don't
automatically take herbs offered by traditional Chinese
practitioners. They could interact with prescription drugs.
Keep
notes about your response to the treatment, and tell your
doctor and acupuncturist about any changes.
Track
your progress. If you have no response at all after four
to six sessions, this therapy may not work for you. Or you may
want to try another therapist, because, as in any therapy, skill
levels vary.
A list of accredited acupuncturists is available through:
National Certification Commission for Acupuncture and Oriental
Medicine
Phone: 703/548-9004
e-mail: info@nccaom.org
Web site: www.nccaom.org
American Academy of Medical Acupuncture
(offers list of medical doctors and osteopathic physicians).
Phone: 800/521-2262
Web site: www.medicalacupuncture.org
Judith Horstman is a contributing editor to Arthritis Today
magazine and author of The Arthritis Foundation's Guide to Alternative
Therapies.
