Acupuncture Research Overview
Clinical research on acupuncture has taken place around the world for decades. Currently, in no small part due to the opioid crisis in the United States, pain research is a key area of focus. In their 2016 Strategic Plan, the National Center for Complementary and Integrative Health (NCCIH) deemed pain a “major public health problem,” and identified “Nonpharmacologic Management of Pain” as a top scientific research priority. The NCCIH Pain Research – Information for Investigators page lists their specific priorities and funding opportunities; their Acupuncture Research page notes the focus on pain management.
Scientific research on mechanisms of action is both important and fascinating. Biomedicine excels when effects have a known cause, and it’s especially useful when those causes and effects can be calibrated and measured. A reported effect, or result, is judged to be valid by the scientific research community only after the experiment has been performed by other researchers, and the same result obtained. The mechanism of action for acupuncture has been studied to an extent, and different hypotheses have been explored. As an acupuncture practitioner and patient, however, I find the mechanism of action to be relatively unimportant. Acupuncturists work with qi, and much like gravity, qi is easy to observe, but not easy to understand. After my interview with and physical examination of patients, I make a diagnosis and develop a treatment strategy and plan, which I then administer. I observe changes in my patients and listen to their self-reported observations, and I know that the treatment has had an impact. However, I don’t know exactly how, on a material level, those needles worked. The language I use with my patients is that all the needles (or moxibustion, cups, or other tool(s)) do is send a message to the body. When my patients improve, it’s because their bodies listened and responded– they did the healing. When a patient doesn’t improve, I believe it’s because I didn’t send the ideal message with needles or other tools using the right technique, or in the right locations.
In my view, one significant challenge to designing high quality clinical trials for acupuncture is the belief on the part of some researchers that “sham” acupuncture– which always requires some sort of physical manipulation and contact with the patient’s skin– is equivalent to an inert placebo (learn more about placebos). For a number of reasons, this is not the case. First of all, it’s difficult to get consensus on what “sham points” are. Different acupuncture traditions locate points in slightly different places, and most experienced acupuncture practitioners would agree that any physical stimulation of the body exerts an energetic effect. Second, any microtrauma to the skin causes local physiological changes, no matter where the trauma occurs. Local blood flow is stimulated, histamines are released, and non-specific pain modulation occurs as pain signals are jammed (as with a burn). Finally, because the mechanism of verum acupuncture is not yet scientifically known, it is difficult (if not impossible) to design an appropriate “sham” treatment – one that we are certain will not work by that same mechanism.
I think it’s of greater value to focus future efforts on comparative effectiveness research. Acupuncture is a safe, relatively low-cost, and gentle intervention that has been proven to cause almost no harm; the side effects and complications resulting from some types of pharmaceutical use and surgeries warrant serious examination of acupuncture as an alternative.