Sunday, 23 June 2013


Acupuncture is a collection of procedures involving penetration of the skin with needles in order to stimulate certain points on the body. In its classical form it is a characteristic component of traditional Chinese medicine (TCM), and one of the oldest healing practices in the world. According to traditional Chinese medicine, stimulating specific acupuncture points corrects imbalances in the flow of qi through channels known as meridians. Scientific investigation has not found any histological or physiological correlates for traditional Chinese concepts such as qi, meridians, and acupuncture points, and some contemporary practitioners use acupuncture without following the traditional Chinese approach.

Research suggests that traditional forms of acupuncture are more effective than placebos in the relief of certain types of pain and post-operative nausea. Recent systematic reviews found that acupuncture also seems to be a promising treatment option for anxiety, sleep disturbances, and depression, but that further research is needed in these regards. Although minimally invasive, the puncturing of the skin with acupuncture needles poses problems when designing trials that adequately controls for placebo effects. A number of studies comparing traditional acupuncture to sham procedures found that both sham and traditional acupuncture were superior to usual care but were themselves equivalent; findings apparently at odds with traditional Chinese theories regarding acupuncture point specificity.

Acupuncture's use for certain conditions has been endorsed by the United States National Institutes of Health, the National Health Service of the United Kingdom, the World Health Organization, and the National Center for Complementary and Alternative Medicine.Some scientists have criticized these endorsements as being unduly credulous and not including objections to or criticisms of the research used to support acupuncture's effectiveness. There is general agreement that acupuncture is relatively safe when administered by qualified practitioners using sterile needles and carries a very low risk of serious adverse effects.

Acupuncture is effective for some but not all conditions." Its effects may be due to placebo. Evidence for the treatment of psychological conditions other than pain is equivocal. Acupuncture appears to be most effective in symptomatic control of pain and nausea. There is general agreement that acupuncture is safe when administered by well-trained practitioners using sterile needles.

It is difficult to design research trials for acupuncture. Due to acupuncture's invasive nature, one of the major challenges in efficacy research is in the design of an appropriate placebo control group. The most commonly proposed placebo control has been "sham acupuncture" to control for different aspects of traditional acupuncture. This includes needling sites not traditionally indicated for treatment of a specific condition to control for the effectiveness of traditional acupuncture for specific conditions and/or needling performed superficially or using retracting needles or non-needles (including toothpicks) to control for needle penetration and stimulation.

A 2012 meta-analysis found significant differences between true and sham acupuncture, which indicates that acupuncture is more than a placebo when treating chronic pain (even though the differences were modest). A 2010 systematic review also suggested that acupuncture is more than a placebo for commonly occurring chronic pain conditions, but the authors acknowledged that it is still unknown if the overall benefit is clinically meaningful or cost-effective.

A 2009 review, however, concluded that the specific points chosen to needle does not matter, and no difference was found between needling according to "true" points chosen by traditional acupuncture theory and "sham" acupuncture points unrelated to any theory. The authors suggested four possible explanations for their observed superiority of both "true" and sham acupuncture over conventional treatment, but lack of difference in efficacy between "true" and sham acupuncture Other authors have suggested randomized controlled trials may under-report the effectiveness of acupuncture as the "sham" treatment may still have active effects, though this position undercuts the traditional theory of acupuncture which associates specific acupuncture points with specific and distinct results. Publication bias is also listed as a concern in the design of randomized trials of acupuncture. A review of studies on acupuncture found that trials originating in China, Japan, Hong Kong and Taiwan were uniformly favourable to acupuncture, as were ten out of 11 studies conducted in Russia. A 2011 assessment of the quality of randomized controlled trials on TCM, including acupuncture, concluded that the methodological quality of most such trials (including randomization, experimental control and blinding) was generally poor, particularly for trials published in Chinese journals (though the quality of acupuncture trials was better than the drug-related trials). The study also found that trials published in non-Chinese journals tended to be of higher quality





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