About acupuncture…

“I’m afraid of needles, except acupuncture needles.” Catherine O’Hara.

Dr. Adrian White (1) defines Western Medical Acupuncture as ‘a therapeutic modality involving the insertion of fine needles; it is an adaptation of Chinese acupuncture using current knowledge of anatomy, physiology and pathology, and the principles of evidence based medicine’.

My name is Dr. Max Forrester. I originally trained a General Practitioner (GP) and was first interested in acupuncture in the 1980’s and then again as a GP Locum in the 1990’s. I did my initial training with the British Medical Acupuncture Society (BMAS) in 1994 where one of my tutors was Dr. Adrian White (1). I attained an MSc in Western Medical Acupuncture from the University of Hertfordshire in 2013. My special interests are self-acupuncture (2, 3) and electroacupuncture.

The known history of acupuncture goes back to 3200 BCE. The Tyrolean Iceman has been well studied after his discovery in 19 September 1991 by two German tourists (4). His tattoos are at the approximate site of acupuncture points on meridians. Acupuncture may have arisen as a therapeutic modality in multiple cultures around the world around 5,000 to 10,000 years ago. There is speculation that the non-decorative tattoos on one of the Pazyryk bodies may be therapeutic (4) for back pain, after all their society lived with, rode, and were buried with their dead horses, 2,500 years ago (5). Contemporary Siberian tribesmen still practice tattooing to relieve back pain (6).

Tradition acupuncture philosophy is based on what has been recorded in China dating back to The Yellow Emperor’s classic of medicine (7). The earliest reference to this work found by Veith (8) was a record in the Former Han Dynasty, about 206 BCE – 25 CE (9).

Contemporary practice of acupuncture in the UK varies considerably from practitioner to practitioner, but on the whole two main approaches can be defined. The approach taught by the BMAS involves the use of acupuncture as a therapy following orthodox clinical diagnosis (10). Points are chosen based on neurophysiological principles. Local needling of trigger points, tender points and acupuncture points predominates in treating somatic pathology, and segmental needling is used to enhance the effect, or if local needling is inappropriate, such as in visceral conditions. This approach is often referred to as ‘Western medical acupuncture’ (1,10,11). The other approach is based on different interpretations of Chinese acupuncture.

How does acupuncture work?

The modern scientific explanation is that needling the acupuncture points stimulates the nervous system to release chemicals in the muscles, spinal cord, and brain. These chemicals will either change the experience of pain, or they will trigger the release of other chemicals and hormones that influence the body’s own internal regulating system (12).

The general effects of acupuncture can be reviewed by watching Thomas Lundeburg explaining the neurophysiology of acupuncture and pain (13).

What about “Trigger Points”?

Defined as: Pain arising from an active myofascial trigger point. It is a hyperirritable locus within a taut band of skeletal muscle or its associated fascia. It is painful on compression and can evoke a characteristic referral pattern of pain or autonomic dysfunction. It may exhibit a jump sign or twitch response (14). In other words a trigger point (TrP) is a tender point in a taut band of muscle that can cause referred pain.

What is the evidence base for WMA?

https://www.nhs.uk/conditions/acupuncture/

Acupuncturists, like everybody else, have to be careful not to mislead the public when advertising. The Advertising Standards Authority “has ruled that the following claims are likely to be acceptable”:

  • Short-term improvement in the symptoms of overactive bladder syndrome (through electro-acupuncture at the SP6 point)
  • Short-term relief of tension type headaches
  • Short-term relief of migraine headache
  • Short-term relief of chronic low back pain
  • Short-term relief of neck pain or chronic neck pain
  • Short-term relief from temporomandibular (TMD/TMJ) pain
  • Temporary adjunctive treatment for osteoarthritis knee pain

https://www.asa.org.uk/advice-online/health-acupuncture.html#Anchor%202

Why have medical acupuncture?

What a patient says (2). This is an open access paper (15).

References

  1. White, A. Western medical acupuncture: a definition. Acupuncture in Medicine. 2009;279(1): 33–35.
  2. Dyer L, Venton K, Forrester M. Home electroacupuncture for persistent postsurgical pain: a patient’s report. Acupuncture in Medicine. 2013 Aug 22:acupmed-2013.
  3. Forrester M. Self-acupuncture. In: Filshie J, White A, Cummings M. (eds). Medical Acupuncture: A Western Scientific Approach. 2nd London: Elsevier; 2016. p. 191-202.
  4. Dorfer L, Moser M, Bahr F, Spindler K, Egarter-Vigl E, Giullén S, Dohr G, Kenner T. A medical report from the stone age?. The Lancet. 1999 Sep 18;354(9183):1023-5.
  5. Argent G. Inked: Human-horse apprenticeship, tattoos, and time in the Pazyryk world. Society & animals. 2013 Jan 1;21(2):178-93.
  6. Scutt RW, Gotch C. Art, sex and symbol: The mystery of tattooing. AS Barnes; 1974.
  7. Ni M. The Yellow Emperor’s classic of medicine: a new translation of the Neijing Suwen with commentary. Shambhala Publications; 1995.
  8. Huang-Ti E, Veith I. Huang Ti Ching Su Wên: The Yellow Emperor’s Classic of Internal Medicine. Chapters 1-34 Translated… with an Introductory Study. Williams & Wilkins; 1949.
  9. Entrikin I. The Yellow Emperor’s Classic of Internal Medicine. Bulletin of the Medical Library Association. 1950 Jul;38(3):280.
  10. White A, Cummings M, Filshie J. An Introduction to Western Medical Acupuncture. 
London: Churchill Livingstone 2008.
  11. Filshie J, Cummings TM. Western medical acupuncture. In: Ernst E, White A, eds. Acupuncture – A Scientific Appraisal. Oxford: Butterworth Heinemann 1999. 31–59.
  12. http://www.medicalacupuncture.org/For-Patients/Articles-By-Physicians-About-Acupuncture/Doctor-Whats-This-Acupuncture-All-About [Accessed 29th April 2017].
  13. https://www.youtube.com/watch?v=oBWmzXfyGHs [Accessed 29th April 2017]
  14. Travell JG, Simons DG. Myofascial Pain & Dysfunction. The Trigger Point Manual. Volume
1. The Upper Extremities. Baltimore: Williams & 17 Wilkins 1983.
  15. https://journals.sagepub.com/doi/pdf/10.1136/acupmed-2013-010421[Accessed 9th February 2019]