Acupuncture, a word that describes a family of procedures for stimulating various specific points on the body, is most often done in the U.S. by penetrating the skin with thin, solid, metallic needles. The needles are manipulated by the hands of the acupuncturist or by electrical stimulation. The approach may draw on various medical traditions, some dating back more than 2,000 years, from China, Japan, Korea, and other countries.
Does acupuncture really work? Our subscribers certainly like their acupuncturists. Of all the services for which we collect Neighbor-to-Neighbor comments, acupuncturists are at the very top for customer satisfaction. Only two percent gave their acupuncturists a "not recommended" rating. That compares to rates of seven percent "not recommended" for physical therapists, eight percent for orthodontists, and much worse percentages for many types of non-healthcare-related services—for example, 10 percent for financial advisors, 16 percent for architects, and 20 percent for house painters.
The federal government’s National Institutes of Health (NIH) convened a "consensus conference" in 1997 to look at various questions about acupuncture, including evidence on acupuncture’s effectiveness. The NIH Consensus Statement on Acupuncture concluded:
"While there have been many studies of [acupuncture’s] 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. Further research is likely to uncover additional areas where acupuncture interventions will be useful."
Since the date of that statement, there have been other clinical trials. Again, the results are not always consistent. But some have been quite positive. For example, a controlled study of acupuncture treatment for people with osteoarthritis of the knee, funded by the NIH’s National Center for Complementary and Alternative Medicine, concluded in 2004 that acupuncture provided pain relief, improved function of the knee, and served as an effective complement to standard care.
While the evidence on the effectiveness of acupuncture for many conditions is not conclusive, that doesn’t mean you shouldn’t try it. The NIH Consensus Statement had this to say:
"One of the advantages of acupuncture is that the incidence of adverse effects is substantially lower than that of many drugs or other accepted medical procedures used for the same conditions. As an example, musculoskeletal conditions, such as fibromyalgia, myofascial pain, and tennis elbow, or epicondylitis, are conditions for which acupuncture may be beneficial. These painful conditions are often treated with, among other things, anti-inflammatory medications (aspirin, ibuprofen, etc.) or with steroid injections. Both medical interventions have potential for deleterious side effects but are still widely used and are considered acceptable treatments. The evidence supporting these therapies is no better than that for acupuncture." [Emphasis added.]
One of the problems assessing acupuncture and many other therapies is that many ailments simply resolve themselves. The back pain, the Bell’s Palsy, or the insomnia may go away during a course of acupuncture treatment. But these problems might have resolved themselves equally well without the acupuncture. Well-designed randomized clinical trials are needed to assess whether the acupuncture really made a difference.
While the lack of adequate evidence on acupuncture is troubling, it is not nearly as troubling as the lack of evidence for much of what traditional medicine does every day—often at enormous cost. Consider the following from a report by ECRI, a federally funded, evidence-based practice center, that does rigorous assessments of the published and unpublished scientific evidence on dozens of types of procedures. These words are from an ECRI assessment of the evidence for laser discectomy for the treatment of herniated discs in the lumbar (lower) portion of the back, a procedure that is widely used and promoted by the surgeons who do it, and that costs roughly $8,000 to treat a single disc:
"A lack of controlled studies comparing laser discectomy to either continued conservative therapy [no surgery] or other operative procedures...prevents the construction of any evidence-based conclusions about this technology...
"Given the natural history of herniated lumbar discs, pain relief may be as likely to occur without invasive treatment as with invasive treatment. A controlled trial is therefore needed to determine the actual extent to which laser discectomy achieves pain relief beyond that of the natural course of the disorder."
At ECRI and other centers that rigorously evaluate the evidence base for many costly and risky traditional medical procedures, conclusions like that are common.
Everything else being equal, select a certified acupuncturist. Although there are competent acupuncturists who are not certified, there are plenty of certified ones, so you may as well take advantage of this quality check.
Unless the acupuncturist is a physician, check for certification by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). To become certified by the NCCAOM, a candidate must complete an approved Master’s-level education program (at least three years in length) or must complete a documented apprenticeship including at least 4,000 hours. In addition, the candidate must pass an examination. An NCCAOM-certified acupuncturist is entitled to add "Dipl. Ac." after his or her name.
If the acupuncturist is a physician, look for certification by the American Board of Medical Acupuncture (ABMA). To be certified by the ABMA, a candidate must be a medical school graduate, complete at least 300 hours of acupuncture education in an ABMA-approved education program, pass an examination, and complete at least two years of medical acupuncture clinical experience with a case history of not less than 500 medical acupuncture treatments. Alternatively, you might consider a physician who is a member of the American Academy of Medical Acupuncture (AAMA). To be an AAMA member, a physician must attest to having completed at least 200 hours of acupuncture training (but not an acupuncture exam).
You can check for listings of acupuncturists who meet these requirements at the following websites: for the NCCAOM, http://www.nccaom.org/ for the ABMA, http://ww.dabma.org/ for the AAMA, http://www.medicalacupuncture.org/.
Talk with friends about experiences they have had with acupuncturists. You will find a few recent comments from other CHECKBOOK subscribers in the Neighbor-to-Neighbor area of our website.
Talk with your physician or physicians. Some physicians have nothing but disdain for acupuncture, but many consider acupuncture a reasonable treatment option for certain types of cases and have experience with, or patient feedback on, local acupuncturists.
Call the offices of acupuncturists you are considering and ask—
- How long the acupuncturist has been in practice.
- What training, licensing, and certifications the acupuncturist has. If you are talking with the office of a physician or chiropractor, don’t simply assume that your acupuncture treatment will be done by the physician or chiropractor.
- Whether the acupuncturist has experience treating the type of condition or problem you want addressed.
- What techniques the acupuncturist uses. For example, Japanese acupuncture uses fewer and finer needles than Chinese acupuncture, and Korean acupuncture primarily uses points on the hand. You may have no reason to prefer one technique over another, but it makes sense to know what you’ll be paying for.
- Whether the acupuncturist uses disposable needles—a must.
- Whether treatment is likely to be covered by your health insurance plan, and whether any type of physician or plan referral will make coverage more likely.
- What the acupuncturist thinks will be the course of treatment, how long the treatment can be expected to continue, and how soon you can expect to see results. Among the acupuncturists we have surveyed for treatment of an arthritic knee, for example, most said we could expect improvement within one to five sessions.
- How much it will cost.
Since there are many qualified acupuncturists, and since other consumers tend to be especially satisfied with acupuncturists, compared to other types of professionals, it makes sense to pay attention to prices—especially if you have no other reason to prefer one practitioner over another.
Prices quoted by a sampling of area acupuncturists in CHECKBOOK cities for acupuncture treatment for arthritic knee pain are available to subscribers.