Acupuncture in Primary Care

Abstract

Acupuncture is an ancient traditional Chinese medical therapy that is used widely around the world. When practiced by a certified provider, it is safe and often perceived as calming and relaxing for patients. Animal and human studies have found a physiological basis for acupuncture needling in that it affects the complex central and peripheral neuro-hormonal network. Although it is unclear whether acupuncture is beneficial over sham/placebo acupuncture, acupuncture care yields clinically relevant short-and long-term benefits for low back pain, knee osteoarthritis, chronic neck pain, and headache. The integration of acupuncture into a primary care setting also appears to be cost-effective. Furthermore, the practice of acupuncture in primary care involves rigorous training, financial discipline, and art of communication. When it is done correctly, acupuncture proves to be beneficial for both patients and providers. KeywordsAcupuncture/history/standards; Acupuncture Therapy/adverse effects; China; Evidence-Based Medicine; Meta-Analysis; Primary Care General IntroductionAcupuncture is a traditional Chinese medical therapy that uses hair-thin metal needles to puncture the skin at specific points on the body to relieve pain and promote wellbeing. In this paper we provide a historical and philosophical overview of acupuncture and describe its current use in the United States. We will then synthesize the basic scientific theory of acupuncture and present recent clinical evidence of how acupuncture may be used for a broad category of diseases with a specific focus on conditions common to a primary care clinic, including low back pain, osteoarthritis, neck pain and headache. Furthermore, we will discuss the practical issues concerning the integration of acupuncture into primary care to create coordinated, patient-centered care.

National survey of pain clinics in Croatia: Organization and services

“…Prescription of acupuncture in the United States is slowly increasing and it is prescribed as a supplement or replacement method for the treatment of chronic pain syndromes (18). The effectiveness of acupuncture for treatment of chronic pain was analyzed in a series of systematic reviews.…”

The Role of Traditional Chinese Medicine in the Management of Chronic Pain: A Biopsychosocial Approach

“…This study suggested that acupuncture appeared to be a cost-effective clinically relevant intervention with "short-and long-term benefits for low back pain, knee osteoarthritis, chronic neck pain and headache." 27 Knowing that all approaches to the management of chronic pain, whether biomedical or nontraditional (from a Western perspective), have some validity with respect to the literature, the most comprehensive approach to pain management we can offer patients may be to offer the best of both. In a clinical update by the International Association for the Study of Pain titled "Integrative Pain Medicine: A Holistic Model of Care," the author concluded the report by stating, "We cannot afford to ignore these realities: it is imperative that as health care providers we have an open mind to low-cost, low-risk integrative strategies that our patients are already embracing."…”

Clinical acupuncture research in the West

“…In 1997, the NIH held a consensus conference based on reviews and expert presentations of studies published between 1970 and 1997, which laid the foundation for rigorous research in acupuncture over the next decade [2,8]. Finding clear evidence that acupuncture is efficacious for adult postoperative and chemotherapy nausea and vomiting and postoperative dental pain, and may be useful in such conditions as menstrual cramps, tennis elbow, and fibromyalgia, the panel proposed that more rigorously designed research was warranted due to the poor quality of many of the previous trials [2].…”

“…More recent trials often report non-insertion sham, also known as "placebo control," with a device that looks and feels like a real acupuncture needle but has a blunt tip that retracts into a hollow shaft handle and touches the skin without penetration [53]. As shown in Table 2, clinical trials employ this type of control with mixed results, probably because the control triggers minimal physiologic response, but positive studies outweigh the negative [8].…”