Acupuncture

Overview: 
  • Mechanism of action: 
    • Acupuncture is a non-pharmacologic modality that can reduce pain, nausea, anxiety, improve sleep, reduce perioperative opiate use and enhance wellbeing.  It is an excellent modality to use in addition to standard of care for patient-centered symptom management.  
    • The practice of acupuncture involves the insertion of ultra-thin needles through the skin at specific points throughout the body.  
    • Acupuncture is often dismissed by clinicians because we are still elucidating its mechanism of action and multiple studies show comparability of verum to sham acupuncture (while many show superiority of verum).  In contrast, oral acetaminophen or paracetamol, outside of rare indications (migraines), is consistently shown to be similar to placebo in reviews for pain, has an unknown mechanism of action for pain relief, and leads to more presentations for acute liver failure than alcohol yet is first line for pain treatment.  It is difficult not to see the cultural bias.   
    • Acupuncture is thought to exert its health effects by multiple pathways: 
    1. By stimulating the central nervous system to release neurotransmitters and hormones.
    2. Through connective tissue mechanoreceptors via matrix deformation leading to neuromodulation.
    3. In the tradition it comes from, acupuncture is used to balance the flow of qi or chi (often translated as ‘vital energy’ or ‘life energy’) resulting in healing.
Clinical Use: 
  • Onset: Immediate to days
  • Duration: Varies, hours to days, typically increases with frequency and regularity of treatments 
  • Forms:  Needles are sterile, single use, disposable, 0.16 to 0.3mm in diameter, 15 to 60mm in length.
    • Acupuncture can be performed throughout the body, at or distal to sites of discomfort, or by a microsystems (auricular) alone.  
    • Acupuncture can be performed with or without electrical stimulation of the point.
    • A treatment can range from 1 to dozens of needles, typically 6-12.  
  • Dosing: Weekly to daily, typically.  
    • Different treatment approaches benefit from different frequencies of treatment.  For an inpatient service, patients would be seen daily
Special Considerations: 
  • Finding a good clinician is challenging, similar to finding a good physician or allied health practitioner. 
  • UCSF’s Osher Center for Integrative Medicine has highly skilled and experienced acupuncturists.

Contraindications/Side Effects:

Contraindications: 

  • Adults with moderate to severe neutropenia, defined as ANC<500.  No evidence of harm, safety data lacking.
  • C. Difficile isolation.  No evidence of harm, safety data lacking. 

Side effects: (notable/most common side effects)

  • Most common (3%) is pain or discomfort at needle site, typically resolved with removal of needle in seconds to minutes. 
  • Rarely: small hematomas, orthostasis.

 

References: 

Vickers AJ et al. Acupuncture for chronic pain. Individual patient data meta-analysis.  Arch Intern Med. 2012; 172(19): 144401453.

Wu MS, Chen KH, Chen IF, Huang SK, Tzeng PC, et al. (2016) The Efficacy of Acupuncture in Post-Operative Pain Management: A Systematic Review and Meta-Analysis. PLoS ONE 11(3): e0150367.

Langevin et al. Biomechanical response to acupuncture needling in humans J Appl Physiol, 91 (2001), pp. 2471–2478

Langevin HM et al. Mechanical signaling through connective tissue: a mechanism for the therapeutic effect of acupuncture. FASEB J. 2001 Oct;15(12):2275-82.

Melchart et al. Prospective investigation of adverse effects of  acupuncture in 97 733 patients. Arch Intern Med.2004 Jan 12;164(1):104-5.

Author: 
Sanjay Reddy