There is currently limited information on basic questions such as who uses acupuncture, for what indications is acupuncture most commonly sought, what variations in experience and techniques used exist among acupuncture practitioners, and whether there are differences in these patterns by geography or ethnic group. Descriptive epidemiologic studies can provide insight into these and other questions. This information can in turn be used to guide future research and to identify areas of greatest public health concern.
Can the efficacy of acupuncture for various conditions for which it is used or for which it shows promise be demonstrated?
Relatively few high-quality, randomized, controlled trials have been published on the effects of acupuncture. Such studies should be designed in a rigorous manner to allow evaluation of the effectiveness of acupuncture. Such studies should include experienced acupuncture practitioners in order to design and deliver appropriate interventions. Emphasis should be placed on studies that examine acupuncture as used in clinical practice, and that respect the theoretical basis for acupuncture therapy.
Although randomized controlled trials provide a strong basis for inferring causality, other study designs such as used in clinical epidemiology or outcomes research can also provide important insights regarding the usefulness of acupuncture for various conditions. There have been few such studies in the acupuncture literature.
Do different theoretical bases for acupuncture result in different treatment outcomes?
Competing theoretical orientations (e.g., Chinese, Japanese, French) currently exist that might predict divergent therapeutic approaches (i.e., the use of different acupuncture points). Research projects should be designed to assess the relative merit of these divergent approaches, as well to compare these systems with treatment programs using fixed acupuncture points.
In order to fully assess the efficacy of acupuncture, studies should be designed to examine not only fixed acupuncture points, but also the Eastern medical systems that provide the foundation for acupuncture therapy, including the choice of points. In addition to assessing the effect of acupuncture in context, this would also provide the opportunity to determine if Eastern medical theories predict more effective acupuncture points, as well as to examine the relative utility of competing systems (e.g., Chinese vs. Japanese vs. French) for such purposes.
What areas of public policy research can provide guidance for the integration of acupuncture into today's health care system?
The incorporation of acupuncture as a treatment raises numerous questions of public policy. These include issues of access, cost-effectiveness, reimbursement by state, federal, and private payors, and training, licensure, and accreditation. These public policy issues must be founded on quality epidemiologic and demographic data and effectiveness research.
Can further insight into the biological basis for acupuncture be gained?
Mechanisms which provide a Western scientific explanation for some of the effects of acupuncture are beginning to emerge. This is encouraging, and may provide novel insights into neural, endocrine and other physiological processes. Research should be supported to provide a better understanding of the mechanisms involved, and such research may lead to improvements in treatment.
Does an organized energetic system exist in the human body that has clinical applications?
Although biochemical and physiologic studies have provided insight into some of the biologic effects of acupuncture, acupuncture practice is based on a very different model of energy balance. This theory may provide new insights to medical research that may further elucidate the basis for acupuncture.
How do the approaches and answers to these questions differ among populations that have used acupuncture as a part of its healing tradition for centuries, compared to populations that have only recently begun to incorporate acupuncture into health care?
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Conclusions and Recommendations
Acupuncture as a therapeutic intervention is widely practiced in the United States. There have been many studies of its potential usefulness. However, 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 placebo and sham acupuncture groups.
However, promising results have emerged, for example, efficacy of acupuncture in adult post-operative and chemotherapy nausea and vomiting and in post-operative 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 where acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful.
Findings from basic research have begun to elucidate the mechanisms of action of acupuncture, including the release of opioids and other peptides in the central nervous system and the periphery and changes in neuroendocrine function. Although much needs to be accomplished, the emergence of plausible mechanisms for the therapeutic effects of acupuncture is encouraging.
The introduction of acupuncture into the choice of treatment modalities that are readily available to the public is in its early stages. Issues of training, licensure, and reimbursement remain to be clarified. There is sufficient evidence, however, of acupuncture's value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value.
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David J. Ramsay, D.M., D.Phil.
Panel and Conference Chairperson
University of Maryland, Baltimore
Marjorie A. Bowman, M.D., M.P.A.
Professor and Chair
Department of Family Practice and
University of Pennsylvania Health System
Philip E. Greenman, D.O., F.A.A.O.
College of Osteopathic Medicine
Michigan State University
East Lansing, Michigan
Stephen P. Jiang, A.C.S.W.
Association of Asian Pacific Community
Lawrence H. Kushi, Sc.D.
Division of Epidemiology
University of Minnesota School of Public
Susan Leeman, Ph.D.
Department of Pharmacology
Boston University School of Medicine
Keh-Ming Lin, M.D., M.P.H.
Professor of Psychiatry, UCLA;
Director, Research Center on the
Psychobiology of Ethnicity
Harbor-UCLA Medical Center
Daniel E. Moerman, Ph.D.
William E. Stirton Professor of
University of Michigan, Dearborn
Sidney H. Schnoll, M.D., Ph.D.
Division of Substance Abuse Medicine
Professor of Internal Medicine and
Medical College of Virginia
Marcellus Walker, M.D.
Christine Waternaux, Ph.D.
Associate Professor and Chief
Columbia University and New York State
New York, New York
Leonard A. Wisneski, M.D., F.A.C.P.
Medical Director, Bethesda Center
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Abass Alavi, M.D.
"The Role of Physiologic Imaging in the
Investigation of the Effects of Pain and
Acupuncture on Regional Cerebral
Professor of Radiology
Chief, Division of Nuclear Medicine
Hospital of the University of Pennsylvania
Brian M. Berman, M.D.
"Overview of Clinical Trials on
Acupuncture for Pain"
Associate Professor of Family Medicine
Center for Complementary Medicine
University of Maryland School of Medicine
Stephen Birch, Lic.Ac., Ph.D.
"Overview of the Efficacy of Acupuncture
in the Treatment of Headache
and Face and Neck Pain"
Anglo-Dutch Institute for Oriental Medicine
Hannah V. Bradford, M.Ac.
"Late-Breaking Data and Other News From
the Clinical Research Symposium (CRS)
on Acupuncture at NIH"
Society for Acupuncture Research
Xiaoding Cao, M.D., Ph.D.
"Protective Effect of Acupuncture on
Professor and Director
Institute of Acupuncture Research
Shanghai Medical University
Daniel C. Cherkin, Ph.D.
"Efficacy of Acupuncture in Treating Low
Back Pain: A Systematic Review of the
Senior Scientific Investigator
Group Health Center for Health Studies
Patricia Culliton, M.A., L.Ac.
"Current Utilization of Acupuncture by
United States Patients"
Alternative Medicine Division
Hennepin County Medical Center
David L. Diehl, M.D.
Assistant Professor of Medicine
UCLA Digestive Disease Center
University of California, Los Angeles
Los Angeles, California
Kevin V. Ergil, L.Ac.
"Acupuncture Licensure, Training, and
Certification in the United States"
Pacific Institute of Oriental Medicine
New York, New York
Richard Hammerschlag, Ph.D.
"Methodological and Ethical Issues in
Academic Dean and Research Director
Yo San University of Traditional
Santa Monica, California
Ji-Sheng Han, M.D.
"Acupuncture Activates Endogenous
Systems of Analgesia"
Neuroscience Research Center
Beijing Medical University
Joseph M. Helms, M.D.
"Acupuncture Around the World in Modern
American Academy of
Kim A. Jobst, D.M., M.R.C.P.
University Department of Medicine and
Glasgow, Scotland, United Kingdom
Gary Kaplan, D.O.
"Efficacy of Acupuncture in the Treatment
of Osteoarthritis and Musculoskeletal
Medical Acupuncture Research Foundation
Ted J. Kaptchuk, O.M.D.
"Acupuncture: History, Context, and
Center for Alternative Medicine Research
Beth Israel Deaconess Medical Center
Janet Konefal, Ph.D., Ed.D., M.P.H.,
"Acupuncture and Addictions"
Acupuncture Research and Training
Department of Psychiatry and Behavioral
University of Miami School of Medicine
Lixing Lao, Ph.D., L.Ac.
"Dental and Postoperative Pain"
Assistant Professor of Family Medicine
Department of Family Medicine and
University of Maryland School of Medicine
C. David Lytle, Ph.D.
"Safety and Regulation of Acupuncture
Needles and Other Devices"
Center for Devices and Radiological Health
U.S. Food and Drug Administration
Margaret A. Naeser, Ph.D., Lic.Ac.,
"Neurological Rehabilitation: Acupuncture
and Laser Acupuncture To Treat Paralysis
in Stroke and Other Paralytic Conditions
and Pain in Carpal Tunnel Syndrome"
Research Professor of Neurology
Boston University Aphasia Research Center
Veterans Affairs Medical Center