CONDITIONS TREATED

Various health agencies, including the World Health Organization and a National Institutes of Health Consensus panel, have found empirical evidence that acupuncture may be effective treatment for a variety of health disorders. The following is the NIH Consensus Development Conference Statement from November, 1997:

"While there have been many studies of its potential usefulness, many of these studies provide equivocal results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebos and sham acupuncture groups. However, promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program."

At HealthPoint, we pride ourselves on being honest and transparent. As the NIH statement above notes, many of the research studies of acupuncture and related traditional Chinese medicine modalities have suffered from poor design, suffer from small numbers analysis (and therefore may lack statistical power), or lack clarity and/or transparency in reporting. With the involvement of more and more Westerners in the practice of Chinese medicine, as well as groups in China such as the China Cochrane Center, one of 13 research centers world-wide comprising the international Cochrane Collaboration for meta-analyses in evidence based medicine, research design, execution and reporting around Chinese medicine is improving. However, many practitioners are uninformed or not well-versed in research methodology or evidence based medicine.


To be fair, traditional styles of medicine evolved thousands of years prior to the evolution of the scientific method or the application of research methods and quantitative measurement, including randomized controlled trials (RCTs).  As such, it can be difficult, even exasperating, to apply modern methods of research to interventions like acupuncture or herbal medicine, interventions that each involve a multiplicity of factors. It should also be pointed out that the appropriateness of RCTs, which have been quite useful for determining the efficacy of pharmaceuticals and medical devices, has been increasingly questioned, including in respected journals of Western medicine, with regard to a number of Western medicine clinical practices and specialties (learn more), let alone for traditional Chinese medicine interventions.

In January 2017, John McDonald and Stephen Janz investigated systematic reviews and meta-analyses of the literature on acupuncture in order to investigate its effectiveness. The Australian Department of Veterans' Affairs 2010 Alternative Therapies Review and United States Department of Veterans Affairs Acupuncture Evidence Map 2014 (the latter referenced above) were used as baselines, then evidence levels were updated to reflect subsequent research. The reviewers searched PubMed and the Cochrane Library for systematic reviews and meta-analyses from March 2013 to September 2016 (as well as three reviews from October 2016 to January 2017). Evidence levels were graded using National Health and Medical Research Council (NHMRC) levels. Where feasible, risk of bias was assessed using the Cochrane GRADE system. The study found that acupuncture has a “positive effect” on eight conditions (migraine prophylaxis, headache, chronic low back pain, allergic rhinitis, knee osteoarthritis pain, chemotherapy-induced nausea and vomiting, post-operative nausea and vomiting and post-operative pain), a “potential positive effect” on an additional 38 conditions, “unclear/insufficient evidence” for 71 conditions and “no evidence of effect” (not the same as “ineffective”) for five conditions. They also identified evidence of cost-effectiveness for 10 conditions.

In this study, “evidence of positive effect” was defined as referring to reviews with consistent statistically significant positive effects and where authors have recommended the intervention. The term “evidence of potential positive effect” refers to reviews reporting all individual RCTs or pooled effects across RCTs as positive, but where the authors considered the evidence insufficient to draw firm conclusions.

The main contribution of this study was to summarize the current state of evidence for acupuncture and also note how the quantity and the quality of evidence for acupuncture research has generally improved over the period reviewed. There has been a 20% increase in the levels of evidence for acupuncture among the conditions reviewed. McDonald and Janz also reiterated findings from Vickers, Vertosick, and Lewith, et al. (see below) that the effects of acupuncture, at least in some instances, cannot be explained entirely in terms of placebo. By highlighting improvements in the quality of acupuncture research, this study underscores the value of acupuncture as a safe and effective treatment option when compared to pharmacological and surgical interventions for migraine and tension headaches, allergic rhinitis, post-operative and chemotherapy induced nausea and vomiting, post-operative pain, pain of knee osteoarthritis, and chronic low back pain. It is reasonable to conclude from this project that acupuncture as a treatment for these conditions would contribute to improved quality of life for persons suffering from these conditions in most instances.

In January 2014, the Evidence-based Synthesis Program (ESP) Center prepared a report for the Department of Veterans Affairs for the purpose of developing an evidence map of acupuncture by which the VA could make policy decision regarding the use of acupuncture. The results found the following levels of evidence for acupuncture with regard to specific conditions.

Evidence of Good Effect
Pain conditions, particularly headache, chronic pain, migraine.
Evidence of Potential Positive Effect
Cancer-related pain, labor pain, pain of pregnancy, labor pain, TMJ, plantar fasciitis, prostatitis.
Insomnia, smoking cessation, post-operative nausea and vomiting, restless leg syndrome.
Depression, anxiety, schizophrenia, PTSD.


Research studies for medical interventions focus mainly on efficacy, a measure of expected results or outcomes under controlled study conditions. Clinical effectiveness pertains to the effects of interventions in real-world settings. For example, while not listed in the VA study above,
HealthPoint has has good results treating soft-tissue pain such as shoulder pain and elbow pain, as well as fertility problems and certain neurological conditions such as Bell's palsy.

In December 2004, Dr. Brian Berman and his team at the University of Maryland, in a  a well-designed and well-executed randomized controlled trial published in the
Annals of Internal Medicine, found that acupuncture seems to provide improvement in function and pain relief as an adjunctive therapy for osteoarthritis of the knee when compared with credible sham acupuncture and education control groups.

Vickers, Vertosick, and Lewith, et al., writing in
The Journal of Pain in late 2017, described their efforts to update an individual patient data meta-analysis to determine the effect size of acupuncture for four chronic pain conditions, concluded that acupuncture is effective for the treatment of chronic musculoskeletal, headache and osteoarthritis pain. Their research found that the treatment effects of acupuncture linger over time and that the effects cannot be explained solely in terms of placebo effects. They concluded that “referral for a course of acupuncture treatment is a reasonable option for a patient with chronic pain.” There is not currently evidence that acupuncture has efficacy in the treatment of the disease process of arthritis. That is, acupuncture does not appear to alter the disease process of arthritis, but there is evidence that it is valuable as an ajunctive treatment to provide improvement in function and pain relief.

Volumes of research have demonstrated, by the way, that acupuncture is an extremely safe procedure when performed by a properly trained and competent practitioner.

There are currently few well-designed studies in English as to the efficacy or clinical effectiveness of Chinese herbal medicine. But there are two important points here. First, herbs are comprised of various individual chemical constituents. With tens-of-thousands of herbal medicinals in the Chinese medicine materia medica, this makes it extremely difficult and costly to study individual herbs. This problem is compounded by the fact that, in the practice of professional Chinese medicine, herbs are almost always administered as part of a balanced formula containing quite a number of individual herbs. Second, since herbs are in the public domain, there is little incentive for incurring the time and money for detailed analysis, as recouping the associated costs would be nearly impossible. What many people fail to realize is that the administration of herbal formulas often plays a significant role in the treatment plan for conditions other than the pain conditions noted above, including gastrointestinal/digestive problems, gynecological and fertility disorders, urinary disorders, bowel problems (diarrhea or constipation), and inflammatory and autoimmune disorders, to name a few.

All of this is important because while we want patients to have realistic expectations - based on the best available evidence - about Chinese medicine treatment modalities. Unlike some TCM clinics, we don't want to suggest that acupuncture and other modalities Chinese medicine can treat, or are the best treatments, for everything. After all, can something claimed to treat everything really be said to treat anything?

Call us at
952-767-4910 to discuss this information or to schedule an appointment. You can also click here to schedule an appointment.




As with any medical service, we make no claims to cure. We ask that patients be prudent and realistic. Chronic internal medicine disorders, in particular, may require a longer treatment plan, patient compliance, and regular communication between patient and practitioner. Traditional Chinese medicine care should be integrated with Western medicine where appropriate and we advise seriously ill individuals or those with potentially complicated disease to seek credible advice and to work closely with and ask detailed questions of all of their health care providers.



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