Conditions Treated (A-Z)

See also the Fertility page

Acne

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress (Hui 2010).

 Acupuncture may help to treat acne through one or more of the following general mechanisms, but as yet we have no specific information from studies on people with acne:

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007);

  • enhancing natural killer cell activities and modulating the number and ratio of immune cell types (Kawakita 2008);

  • increasing local microcirculation (Komori 2009), which aids dispersal of swelling;

Allergic  rhinitis

 In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress (Hui 2010)

 Acupuncture may help to relieve pain and congestion in people with allergic rhinitis by:

  •  regulating levels of IgE and cytokines, mediators of the allergic reaction to extrinsic allergens (Ng 2004; Rao 2006; Roberts 2008)

  •  stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz, 1987; Han 2004; Zhao 2008; Cheng 2009);

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007);

  • enhancing natural killer cell activities and modulating the number and ratio of immune cell types (Kawakita 2008);

  • increasing local microcirculation (Komori 2009), which aids dispersal of swelling.

Anxiety

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.

Research has shown that acupuncture treatment may specifically benefit anxiety disorders and symptoms of anxiety by:

  • Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Hui 2010).

  • Regulating levels of neurotransmitters (or their modulators) and hormones such as serotonin, noradrenaline, dopamine, GABA, neuropeptide Y and ACTH; hence altering the brain's mood chemistry to help to combat negative affective states (Lee 2009; Samuels 2008; Zhou 2008; Yuan 2007).

  • Stimulating production of endogenous opioids that affect the autonomic nervous system (Arranz 2007). Stress activates the sympathetic nervous system, while acupuncture can activate the opposing parasympathetic nervous system, which initiates the relaxation response.

  • Reversing pathological changes in levels of inflammatory cytokines that are associated with anxiety (Arranz 2007)

  • Reversing stress-induced changes in behaviour and biochemistry (Kim 2009).

Acupuncture can be safely combined with conventional treatments such as medication or psycho-educational therapy, possibly enhancing their beneficial effects (Courbasson 2007) and reducing unwanted side-effects (Yuan 2007).

Arrhythmias and Heart Failure

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.

Research has shown that acupuncture treatment may specifically benefit arrhythmias and heart failure, and help cardiovascular function overall, by:

  • minimising myocardial injury, probably partially by reducing serum cardiac troponin (integral to heart muscle contraction and a marker for damage to the muscle) and C-reactive protein (a marker of inflammation) levels (Ni 2012);

  • regulating MAPK (mitogen-activated protein kinase) signalling pathways (e.g. p38 and JNK) that are involved in cardiovascular pathogenesis such as cardiac hypertrophy, and modulating the upstream neuroendocrine factors that control these pathways (Wang 2012, Li 2012, Wu 2012);

  • reducing plasma levels of adrenaline, noradrenaline (Wang 2009) and vasoactive intestinal peptide (Fan 2010), so suppressing tachycardia;

  • regulating the autonomic nervous system (the main controller for heart rate and rhythm) (Yue 2008, Middlekauf 2002), partly via opiate receptors in the hypothalamus (Zhong 2009);

  • mediating heart rate variability (low HRV is associated with various cardiac pathologies) (Wang 2013);

  • inhibiting cardiovascular function (heart rate, blood pressure) by activating baroreceptor sensitive neurons in the nucleus tractus solitarius (specific to auricular, not body, acupuncture) (Gao 2011);

  • affecting activation of the brain cortex and hence heart function (Kim 2008);

  • acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Hui 2010);

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007).

Asthma

There are many published studies investigating the mechanisms by which acupuncture may have an effect in asthma, showing that it may help relieve asthma by:

  • having regulatory effects on mucosal and cellular immunity in patients with allergic asthma, as shown, for example, by changes in levels of immunoglobulins, eosinophils, T-lymphocytes and cytokines (Yang 2013, Carneiro 2010, Joos 2000);

  • reducing bronchial immune-mediated inflammation, particularly through the balance between T helper 1 and 2 cells and their associated cytokines (Carneiro 2010; Carneiro 2005, Jeong 2002). Reducing inflammation in general by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003);

  • regulating expression of surfactant proteins, that help to reduce airways resistance biophysically and also modulate the immune response (Yan 2010);

  • inhibiting structural changes in the airways, and hence reducing airways resistance, possibly by inhibiting T-type calcium channel protein in airway smooth muscle cells (Wang 2012);

  • regulating the expression of genes and proteins that control the airways inflammatory response (Mo 2012, Xu 2012, Yin 2009);

  • acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Hui 2010).


Back pain

Research has shown that acupuncture is significantly better than no treatment and at least as good as (if not better than) standard medical care for back pain (Witt 2006; Haake 2007; Cherkin 2009; Sherman 2009a). It appears to be particularly useful as an adjunct to conventional care, for patients with more severe symptoms and for those wishing to avoid analgesic drugs (Sherman 2009a, 2009b; Lewis 2010). It may help back pain in pregnancy (Ee 2008) and work-related back pain, with fewer work-days lost (Weidenhammer 2007; Sawazaki 2008).

  • Acupuncture can help back pain by: 
    providing pain relief - by stimulating nerves located in muscles and other tissues, acupuncture leads to release of endorphins and other neurohumoral factors and changes the processing of pain in the brain and spinal cord (Pomeranz 1987; Zhao 2008).

  • reducing inflammation - by promoting release of vascular and immunomodulatory factors (Kim 2008, Kavoussi 2007; Zijlstra 2003).

  • improving muscle stiffness and joint mobility - by increasing local microcirculation (Komori 2009), which aids dispersal of swelling and bruising.

  • reducing the use of medication for back complaints (Thomas 2006).
    providing a more cost-effective treatment over a longer period of time (Radcliffe 2006; Witt 2006).

  • improving the outcome when added to conventional treatments such as rehabilitation exercises (Ammendolia 2008; Yuan 2008).

Bell's palsy

Acupuncture may help in the treatment of Bell's palsy by: 

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kim 2008, Kavoussi 2007, Zijstra 2003);

  • enhancing local microcirculation, by increasing the diameter and blood flow velocity of peripheral arterioles (Komori 2009);

  • nerve and muscular stimulation (Cheng 2009).
    Cancer care


Cancer Care

Pain
One systematic review provided limited evidence that acupuncture may provide long-term pain relief in patients with cancer (Paley 2011). The review found there was a shortage of good quality trials, though more recent examples have strengthened the evidence. For example, one found it more effective than usual care for pain and dysfunction after neck dissection (Pfister 2010); in another it was more effective than cobamamide for peripheral neuropathy due to chemotherapy (Xu 2010); and a third found it to be better than sham acupuncture for joint symptoms caused by aromatase inhibitors (Crew 2010).

Fatigue
Two small randomised controlled trials showed that acupuncture may be more effective than sham acupuncture (Balk 2010; Molassiotis 2007), but further data is needed to make a convincing case.

Xerostomia (radiotherapy-induced).
A systematic review found possible benefits with acupuncture (O'Sullivan 2010), though not all the inter-group differences were significant.

Leukopaenia
A systematic review concluded acupuncture may possibly be effective for chemotherapy-induced leukopaenia (Lu 2007), though the studies were of poor quality. More recent randomised controlled trials found it to increase granulocyte colony-stimulating factor and improve leukopaenia (Han 2010), and to increase white blood cell values (Lu 2009).

Vasomotor symptoms
One systematic review of three trials in women with breast cancer (Lee 2009a), plus a further four more recent trials (Frisk 2011; Liljegren 2010; Walker 2010; Hervik 2009), provide mixed results from which it is hard to draw definite conclusions. Acupuncture has been found superior to sham in two out of three; better than venlafaxine in one out of two; similar to relaxation; and less effective than hormone therapy (but without the serious side effects). There is also a systematic review in respect of men with prostate cancer: the results were promising but very much preliminary (Lee 2009b).

Nausea and vomiting
Three systematic reviews found that moxibustion or acupuncture can help relieve nausea and vomiting (Lee 2010; Chao 2009; Ezzo 2006), especially in acute situations. There is more about the effects of acupuncture on these symptoms in the Nausea and Vomiting factsheet.

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.

Research has shown that acupuncture treatment may specifically benefit symptoms associated with cancer and its treatment by:

  • Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);

  • Regulating neurotransmitters (or their modulators) and hormones such as serotonin, noradrenaline, dopamine, GABA, neuropeptide Y and ACTH; hence altering the brains's mood chemistry to help to combat negative affective states (Lee 2009; Cheng 2009; Zhou 2008);

  • Increasing the release of adenosine, which has antinociceptive properties (Goldman 2010);

  • Improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which aids dispersal of swelling;

  • Stimulating production of endogenous opioids that affect the autonomic nervous system (Arranz 2007). Stress activates the sympathetic nervous system, while acupuncture can activate the opposing parasympathetic nervous system, which initiates the relaxation response;

  • Reversing pathological changes in levels of inflammatory cytokines (Arranz 2007);

  • Reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003);

  • Reversing stress-induced changes in behaviour and biochemistry (Kim 2009);

  • Increasing levels of T lymphocyte subsets such as CD(3), CD(4), and CD(8) , as well as Natural Killer cells (Zhao 2010);

  • Relieving nausea and vomiting by regulating gastric myo-electrical activity (Streitberger 2006) , modulating the actions of the vagal nerve and autonomic nervous system (Huang 2005), and regulating vestibular activities in the cerebellum (Streitberger 2006);
    Reducing vasopressin-induced nausea and vomiting and suppressing retrograde peristaltic contractions (Tatewaki 2005).


    NB
    ?Acupuncture may be used for some of the symptoms of cancer, and the side effects of conventional cancer treatments, but it is not used to address the cancer itself.

Carpal tunnel syndrome

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.

Research has shown that acupuncture treatment may specifically help in the management of carpal tunnel syndrome by:

  • acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);

  • increasing the release of adenosine, which has antinociceptive properties (Goldman 2010);

  • regulating the limbic network of the brain, including the hypothalamus and amygdala (Napadow 2007a);

  • inducing beneficial cortical plasticity (i.e. conditioning the brain to stop processing sensory nerve input from the affected fingers maladaptively, which leads to improved symptoms) (Napadow 2007b).

Childbirth and Pregnancy

An overview of systematic reviews and randomised controlled trials across the whole area of pregnancy found evidence that acupuncture may assist with the management of some complaints, though more studies are needed (Smith 2009).

Systematic reviews of randomised and quasi-randomised controlled trials suggest that acupuncture may help to relieve pain during labour (Cho 2010; Smith 2006). The later review found that acupuncture was superior to conventional analgesia but not, or marginally, better than minimal (sham) acupuncture. Given that 'sham' acupuncture interventions are not inert placebos the effect of 'real' acupuncture may be under-estimated in such trials, and non-superiority should not be taken at face value (Lundeberg 2009). Since that review was compiled there have been further trials supporting the efficacy of electroacupuncture (Ma WZ 2010), moxibustion (Ma SX 2010) and acupressure (Hjelmstedt 2010).

Several systematic reviews have found that moxibustion has a positive effect in correcting breech presentation (Vas 2009; Li 2009; Van den Berg 2008), though the results from two recent trials go against the general trend (Millereau 2009; Guittier 2009). A modelling study based on the systematic review data calculated that moxibustion treatment would be cost-effective (van den Berg 2010).

For back and pelvic pain there is a systematic review (Ee 2008) and one subsequent RCT (Wang 2009) indicating that acupuncture may provide effective pain relief. In another recent study (Eldon 2008) acupuncture was significantly superior to sham for functional ability but not pain relief (see above for comments on sham acupuncture comparisons).

There is evidence in favour of acupuncture for depression (Manber 2010), emotional problems in general (da Silva 2007) and dyspepsia (da Silva 2009).
Acupuncture is relatively safe with no records of serious adverse events in the pregnancy-related systematic reviews (Cho 2010; Lim 2009; Vas 2009; Ee 2008).

See Table below for further details of the cited studies.

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation (Hui 2010)

In pregnant women, acupuncture may help to relieve pain (e.g. back pain, labour pain), improve mood and reduce anxiety, alleviate dyspepsia, and turn a foetus who is breech by:

  • increasing relaxation and reducing tension (Samuels 2008). Acupuncture can alter the brain's mood chemistry, reducing serotonin levels (Zhou 2008), and increasing endorphins (Han, 2004) and neuropeptide Y levels (Lee 2009), which can help to combat negative affective states.

  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz, 1987; Zhao 2008; Cheng 2009);

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007);

  • increasing cortico-adrenal secretion, placental estrogens, and changes in prostaglandin levels, which leads to raised basal tone of the uterus and enhanced movement of the foetus, thus making version more likely (Van den Berg 2008).

Chronic fatigue syndrome

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurotransmitters. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for insomnia (Wu 1999).

Acupuncture may help to relieve symptoms of chronic fatigue syndrome such as musculoskeletal pain, headache, sleep problems, tiredness and depression by:

  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz 1987, Zhao 2008).

  • stimulating opiodergic neurons to increase the concentrations of beta-endorphin, so relieving pain (Cheng 2009).

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003).

  • improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which can reduce swelling and pain.

  • reducing insomnia through increasing nocturnal endogenous melatonin secretion (Spence 2004)

Colds and flu

Acupuncture may help relieves symptoms of colds and flu by:

  • enhancing natural killer cell activities and modulating the number and ratio of immune cell types (Kawakita 2008);

  • reducing pain through the stimulation of nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors (Pomeranz 1987);

  • reducing inflammation through the release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003);

  • increasing local microcirculation (Komori 2009), which aids dispersal of swelling.

COPD

Acupuncture may help relieve COPD by:

  • reducing bronchial immune-mediated inflammation (Carneiro 2005), and reducing inflammation in general by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003).

  • improving both airway mucociliary clearance and the airway surface liquid (Tai 2006).

  • regulating cytokine production (Jeong 2002, Joos 2000).

Coronary heart disease

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.

There are many published studies from China investigating the mechanisms by which acupuncture may affect heart disease. Nearly all have used electro-stimulation in animal models of myocardial ischaemia. Research has shown that acupuncture treatment may benefit coronary heart disease by:

  • minimising myocardial injury, probably partially by reducing serum cardiac troponin I and C-reactive protein levels (Ni 2012);

  • inhibiting cardiac sympathetic nervous system activity (and hence noradrenaline and adrenaline), in order to relieve myocardial ischaemia (Li 2012a; Zhou 2012);

  • activation of myocardial opioid receptors, and subsequent signalling by protein kinases such as PKC, has a protective effect against ischaemia (Zhou 2012);

  • lowering levels of myocardial enzymes (serum aspartate aminotransferase, isoenzymes of creatine kinase, lactate dehydrogenase, creatine kinase, and alpha-hydroxybutyrate dehydrogenase) to prevent ischaemic myocardial injury (Huang 2012);

  • regulating nerve electrical activity in the spinal dorsal roots and concentrations of norepinephrine and dopamine in the paraventricular nucleus of the hypothalamus (Li 2012b);

  • regulating JNK signalling pathways (mitogen-activated protein kinases that transmit signals of stress stimuli)?to possibly?prevent and treat cardiac hypertrophy?(Wang 2012);

  • activating baroreceptor sensitive neurons in the nucleus tractus solitarius in a similar manner to the baroreceptor reflex in cardiovascular inhibition (Gao 2011);

  • upregulating myocardial nitric oxide and nitric oxide synthase content and downregulating myocardial intracellular calcium levels, which may contribute to its effect in relieving myocardial injury (Wang 2010);

  • acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Hui 2010);

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007).

Cystitis

Acupuncture may help in the treatment of cystitis by:

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kim 2008, Kavoussi 2007, Zijstra 2003); reducing pain and swelling (Lorenzini 2010)

  • improving bladder irritation by inhibition of capsaicin-sensitive C-fibre activation (Hino 2010).


Dementia

How acupuncture can help

This factsheet focuses on the evidence for acupuncture in dementia. One systematic review found that the evidence available for acupuncture does not demonstrate effectiveness in Alzheimer's disease (Lee 2009), although only three randomised controlled trials (RCTs) were located for this. By contrast, a review for dementia in general found 22 RCTs, which demonstrated a significant positive advantage for acupuncture over control groups (Gu 2008). Since most of the trials were for vascular dementia, it's notable that a Cochrane review one year earlier had found no suitable RCTs at all for this condition (Peng 2007)

There have been several randomised controlled trials published since these systematic reviews, all with promising results. All are for vascular dementia (not Alzheimer's) and all are from China. All of them compared acupuncture to medication; two also used a combined acupuncture plus medication group. In five trials, acupuncture was significantly better than medication (Zhang 2011, Chen 2011, Wang 2010, Zhang 2008, Liu 2008b) and in three it was similar in effect (Zhao 2009, Chen 2009, Liu 2008a). Various different acupuncture treatment modalities were used: manual needling (Zhang 2011, Liu 2008a), electroacupuncture (Zhao 2009, Zhang 2008, Liu 2008b), moxibustion (Chen 2011, Wang 2010) and ear taping/pressing (Chen 2009). Most studies used recognised outcomes measures relevant to dementia and some also investigated possible biochemical mechanisms (see below).?

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.

Research has shown that acupuncture treatment may specifically help in dementia by:

  • regulating neuropeptide substances (somatostatin and arginine vasopressin) relevant to learning and memory (Chen 2011; Wang 2010);

  • reducing the levels of 8-OHdG (Shi 2012) and decreasing lipid peroxidation in the brain (Zhu 2010; Yang 2007), suggesting that acupuncture helps to prevent oxidative damage;

  • activating certain cognitive-related regions in the brain (Wang 2012);

  • decreasing the overproduction of nitric oxide and strengthening the ability to eliminate free radicals (He 2012);

  • decreasing cholinergic neuron damage and reducing the abnormal activation and hyperplasia of astrocytes (Miao 2009);

  • decreasing the number of activated glial cells so as to protect the neurons (Zhu 2009);

  • lowering acetylcholinesterase activity (Yang 2007);

  • suppressing vascular dementia-induced increase of interleukin-1beta and tumour necrosis factor-alpha levels in the hippocampus (Li 2007);

  • improving glucose metabolism in the bilateral frontal lobes, bilateral thalamus, temporal lobe and lentiform nucleus (Chen 2006);

  • acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);

  • increasing the release of adenosine, which has antinociceptive properties (Goldman 2010).

Dentistry

How acupuncture can help

(Bensoussan 1999, Rosted 1998, Ernst 1998). Controlled trials have shown that ear acupuncture is as effective as intranasal midazolam in reducing dental anxiety (Karst 2007), and that acupuncture is more effective than placebo in the prevention of post-operative dental pain (Lao 1999) and in reducing the gagging reflex (Sari 2010). Evidence from case series suggests that acupuncture can reduce dental anxiety (Rosted 2010) and the gagging reflex (Rosted 2006), and that electroacupuncture can control post-operative pain after wisdom tooth extraction (Tarares 2007). One controlled study found no effect on the pain threshold of dental pulp (Goddard 2009).

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety (Wu 1999).

Acupuncture may help relieve dental pain by:

  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors (e.g. neuropeptide Y, serotonin), and changes the processing of pain in the brain and spinal cord (Pomeranz 1987, Han 2004, Zhao 2008, Zhou 2008, Lee 2009, Cheng 2009);
  • reducing the cardiovascular reflex elicited by toothache, which is associated with the adrenergic system (Jung 2006);
  • increasing the release of adenosine, which has antinociceptive properties (Goldman 2010);
  • modulating the limbic-paralimbic-neocortical network (Hui 2009);
  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003);
  • increasing local microcirculation (Komori 2009), which aids dispersal of swelling.

Depression

How acupuncture can help

Most research on acupuncture for depression has been carried out in China with Western drugs as comparators. Two recent systematic reviews, both drawing on Western and Chinese data, found that acupuncture was similar in effectiveness to anti-depressant medication and not significantly better than sham acupuncture or waiting list controls. However, they reached very different conclusions, one recommending acupuncture (Zhang 2010) and one stating that the evidence was insufficient (Smith 2010). Major issues to consider in respect of the research evidence are a) how trustworthy are Chinese studies (Ernst 2010), b) how valid are sham controlled trials (Schroer 2010), and c) how relevant to normal practice is the acupuncture provided in trials (Schroer 2010). Notions about acupuncture's placebo properties (Ernst 2010) can only be speculative, and with little relevance to decisions about patient benefit. Given that acupuncture appears to be at least as effective as existing conventional drugs, without their level of side effects, it should be considered as one of the therapeutic options, alongside the existing repertoire. Two specific situations, during pregnancy (Manber 2010) and post-stroke (Zhang 2010; Smith 2010), seem to be particularly favourable for incorporating acupuncture treatment. (See table overleaf)

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional wellbeing.

Studies indicate that acupuncture can have a specific positive effect on depression by altering the brain's mood chemistry, increasing production of serotonin (Sprott 1998) and endorphins (Wang 2010). Acupuncture may also benefit depression by acting through other neurochemical pathways, including those involving dopamine (Scott 1997), noradrenaline (Han 1986), cortisol (Han 2004) and neuropeptide Y (Pohl 2002).

Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain which is responsible for anxiety and worry (Hui 2010).? Stress-induced changes in behaviour and biochemistry may be reversed (Kim 2009).

Some of the most recent research suggests that depression is associated with dysfunction in the way that parts of the resting brain interact with each other (Broyd 2008); acupuncture has been shown to be capable of changing the 'default mode network' (Dhond 2007), but the effect goes beyond that of expectation/placebo (Hui 2010).
Acupuncture can be safely combined with conventional medical treatments such as anti-depressants, helping to reduce their side effects and enhance their beneficial effects (Zhang 2007).

Acupuncture treatment can also help resolve physical ailments such as chronic pain (Zhao 2008), which may be a contributing cause of depression. In addition to offering acupuncture and related therapies, acupuncturists will often make suggestions as to dietary and other lifestyle changes that may be helpful in overcoming depression. Finally, people struggling to cope with depression usually find that coming to see a supportive therapist on a regular basis is helpful in itself.

Dysmenorrhoea (period pains)

How acupuncture can help

Acupuncture may help reduce symptoms of dysmenorrhoea by:

  • regulating neuroendocrine activities and the related receptor expression of the hypothalamus-pituitary-ovary axis (Liu 2009; Yang 2008)

  • increasing nitric oxide levels, which relaxes smooth muscle and hence may inhibit uterine contractions (Wang 2009)

  • increasing relaxation and reducing tension (Samuels 2008). Acupuncture can alter the brain's mood chemistry, reducing serotonin levels?(Zhou 2008) and

  • increasing endorphins (Han, 2004) and neuropeptide Y levels (Lee 2009), which can help to combat negative affective states

  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz, 1987; Zijlstra 2003; Cheng 2009);

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007)


Eczema and Psoriasis

How acupuncture can help? In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress (Hui 2010)

Acupuncture may help to relieve symptoms in people with atopic eczema and psoriasis by:

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007);

  • regulating mediators of the allergic reaction to extrinsic allergens, for example Ig-E (Rao 2006), serum cytokines (IL-2, IL-4, IL-10, IFN-, Ig-E) (Okumura 2002), and basophils (Pfab 2011);

  • enhancing natural killer cell activities and modulating the number and ratio of immune cell types (Kawakita 2008);

  • increasing local microcirculation (Komori 2009), which aids dispersal of swelling;

Endometriosis

How acupuncture can help

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress (Wu 1999).

There is preliminary evidence to support acupuncture as an effective treatment for endometriosis, with one small sham controlled trial (Wayne 2008) and a few comparative studies against Western medication (Yan 2008, Xia 2006, Sun 2006), though further research is needed to confirm this.

It has been shown that acupuncture treatment may specifically be of benefit in people with endometriosis by:

  • providing pain relief - by stimulating nerves located in muscles and other tissues, acupuncture leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Zhao 2008, Han 2004, Zijlstra 2003, Pomeranz 1987).

  • reducing inflammation - by promoting release of vascular and immunomodulatory factors Kavoussi 2007, Zijlstra 2003).

  • regulating levels of prostaglandins (Jin 2009)


Facial pain

How acupuncture can help

This Factsheet focuses on the evidence for acupuncture in the management of facial pain resulting from musculoskeletal conditions such as temporomandibular joint (TMJ) disorder. There are also factsheets on Bell's palsy, dentistry pain, headache, migraine, neuropathic pain (including trigeminal neuralgia) and sinusitis.

There have been 4 systematic reviews on the management of facial pain in TMJ disorder (Jung 2011, La Touche 2010a, Cho 2010, La Touche 2010b). All found evidence that acupuncture may be effective, but all stated that more (and larger, longer) high quality studies are needed to confirm acupuncture's effect in TMJ disorder. Many of the reviewed trials used sham acupuncture control groups (and some reviews analysed only this sort) despite the fact that 'sham' acupuncture interventions are not inert placebos, hence potentially underestimating the effect of 'real' acupuncture (Lundeberg 2011). So far the indications are that acupuncture is superior to sham, to physical therapy and to no treatment, and similar to splinting. Also, it is effective for both acute and chronic pain.

One randomised controlled trial (RCT) published since these systematic reviews found that acupuncture is an effective complement or an acceptable alternative to decompression splints in the treatment of myofascial pain and temporomandibular joint pain-dysfunction syndrome (Vicente-Barrero 2012). Another found that it reduced pain in TMJ disorder more than sham acupuncture (Itoh 2012). However, both of these trials are very small, so the systematic review caveats still hold.

A sample of RCTs from 2007-9 (i.e. prior to the systematic reviews) is included in the table below, to give further examples of the research in this area (Shen 2009, Sima 2009, Shen 2007, Wang 2009).

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.

Research has shown that acupuncture treatment may specifically help in the management of facial pain by:

  • acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009)

  • increasing the release of adenosine, which has antinociceptive properties (Goldman 2010)

  • inducing antinociception by activating the opioid pathway (Almeida 2008a) or the L-arg/NO/cGMP pathway (Almeida 2008b)

  • exciting or inhibiting the anterior temporalis muscle via reflex pathways and thus smoothing jaw opening and closing (Wang 2007)

Female fertility

How acupuncture can help

Randomised trials in China have demonstrated significantly better pregnancy rates for acupuncture than medication (Yang 2005, Chen 2007, Song 2008).

Research has established plausible mechanisms to explain how acupuncture may benefit fertility:

  • regulating fertility hormones - stress and other factors can disrupt the function of the hypothalamic pituitary-ovarian axis (HPOA), causing hormonal imbalances that can negatively impact fertility. Acupuncture has been shown to affect hormone levels by promoting the release of beta-endorphin in the brain, which affects the release of gonadotrophin releasing hormone by the hypothalamus, follicle stimulating hormone from the pituitary gland, and oestrogen and progesterone levels from the ovary (Ng 2008, Huang 2008, Lim 2010, Stener-Victorin 2010). Further details of these processes are emerging, for example mRNA expression of hormones, growth factors and other neuropeptides (He 2009)

  • increasing blood flow to the reproductive organs - stress also stimulates the sympathetic nervous system, which causes constriction of ovarian arteries. Acupuncture inhibits this sympathetic activity, improving blood flow to the ovaries (Stener-Victorin 2006, Lim 2010), enhancing the environment in which ovarian follicles develop. It also increases blood flow to the uterus (Stener-Victorin 1996, Huang 2008), improving the thickness of the endometrial lining and increasing the chances of embryo implantation.

  • counteracting the effects of polycystic ovarian syndrome (PCOS) - PCOS is one of the most common causes of female infertility. By reducing sympathetic nerve activity and balancing hormone levels, acupuncture has been shown to reduce the number of ovarian cysts, stimulate ovulation, enhance blastocyst implantation and regulate the menstrual cycle in women with PCOS (Stener-Victorin 2000, 2008, 2009, Zhang 2009). It may also help to control secondary effects such as obesity and anorexia (Lim 2010).

Female fertility & IVF briefing paper

Acupuncture has positive impact on the birth rate of sub fertile women undergoing IVF/ICSI, studies show.

Key Points

  • A recent high-level review found acupuncture to significantly improve birth rate.

  • A summary of 11 reviews up to 2017 found acupuncture to significantly improve clinical pregnancy rate but scientific methods need to be improved.

  • Experimental research should explore the impact of acupuncture on follicular development with the aim to improve embryo/blastocyst quality.

  • Acupuncture is a suitable treatment option to help reduce stress and anxiety levels.

What should you know?
A recent systematic review and meta-analysis (the highest level of research for evaluating the effects of a treatment) investigated the effects of acupuncture on sub fertile women during in vitro fertilisation (IVF) or intra-cytoplasmic sperm injection (ICSI).[1]

A total of 3,188 sub fertile women from 12 randomised controlled trials were included in this latest investigation.

What did the research find?
Acupuncture significantly improved the live birth rate of sub fertile patients undergoing IVF/ICSI.

Why is this important?
In the UK, the overall birth rate following assisted reproduction is only 21% to 22% (fresh and frozen transfer). The birth rate varies with age and the type of transfer (see Table?1).

Table 1 UK birth rates per embryo transfer [2]

Age Range

Fresh Cycle Transfer

Frozen Cycle Transfer

35 & under

29%

26%

35-37

23%

23%

38-39

15%

21%

40-42

10%

15%

43-44

7%

14%

 

Live birth rate can be considered the most important measure of success for sub fertile people undergoing assisted reproductive treatment.

Acupuncture has been shown to have a significant treatment effect on live birth rates, indicating that it may complement an IVF/ICSI cycle.

What is different about this new systematic review and meta-analysis?
Researchers did not just focus on trials with a limited number of sessions around the time of egg collection or embryo transfer but also included those with more extensive acupuncture treatment.

What has another research indicated?
A recent overview of systematic reviews from 2009 up to 2017, found that acupuncture given at the time of egg collection/embryo transfer improved clinical pregnancy rates x [3].

One very recent trial from Australia is not included in the reviews discussed above [4]. It was the largest randomised trial so far of acupuncture with IVF but technical issues make its conclusions hard to relate to routine clinical practice.

A 2018 trial from China looked specifically at having acupuncture just during the follicular phase of IVF/ICSI and found it improved ovarian blood supply and pregnancy rates [5].

Acupuncture improves emotional wellbeing during IVF
Assisted reproduction treatment can be stressful and interventions to support the psychological impact of subfertility and fertility treatment should be offered. Studies indicate that acupuncture treatment can reduce stress and/or anxiety and increase women's ability to cope with the IVF process [6].

When should I have acupuncture?
A comprehensive acupuncture treatment management strategy may be required leading up to an IVF/ICSI cycle (pre-treatment), and then during ovarian stimulation, with an aim to influence the development of ovarian follicles. In addition, treatment may also be provided around embryo transfer, and shortly afterwards during the two-week wait prior to a pregnancy test, to possibly influence implantation and relieve stress and anxiety resulting from uncertainty.

Research indicates that the effectiveness of acupuncture may be dose-dependent, i.e. you need to have a sufficient number of sessions over an adequate period of time.


References
1. Zhang X et al (2018). Effects of acupuncture during in vitro fertilization or intracytoplasmic sperm injection: An updated systematic review and meta-analysis. European Journal of Integrative Medicine 23: 14?25.
2. Human Fertilisation & Embryology Authority (2018). Fertility treatment 2014?2016: Trends and figures. Available at:?https://www.hfea.gov.uk/media/2563/hfea-fertility-trends-and-figures-2017-v2.pdf?[23 October 2018].
3. Xi J et al (2018). Effects of Acupuncture on the Outcomes of Assisted Reproductive Technology: An Overview of Systematic Reviews. Evid Based Complement Alternat Med 2018:7352735.
4. Smith CA et al (2018). Effect of Acupuncture vs Sham Acupuncture on Live Births Among Women Undergoing In Vitro Fertilization: A Randomized Clinical Trial. JAMA 319(19):1990-1998.
5. Xu ZZ, Gao Y (2018). Effects of acupuncture on ovarian blood supply and pregnancy outcomes in patients receiving assisted reproduction. Journal of Acupuncture and Tuina Science 16(4):253-259
6. Smith CA et al (2014). The effect of acupuncture on psychosocial outcomes for women experiencing infertility: a pilot randomized controlled trial. J Altern Complement Med 17(10):923-30

Fibromyalgia

How acupuncture can help

The most recent research (Langhorst 2010), with more trials included, reported acupuncture to have a significantly better analgesic effect than sham (though it was not superior for other symptoms). Another recent review, with access to the Chinese literature, was able to assess the effectiveness of acupuncture against conventional medication, as well as against sham (Cao 2010). This found it to be better than drugs in terms of pain relief.

Acupuncture may have the greatest benefit when applied together with medication or other therapeutic options (Targino 2008, Jang 2010). Further trials are needed, of larger size and with sounder methodology, and especially those that compare acupuncture to existing conventional interventions. [See Table below]

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety (Wu 1999).

Acupuncture may help relieve pain in patients with fibromyalgia by:

  • altering the brain's chemistry, increasing endorphins (Han 2004) and neuropeptide Y levels (Lee 2009; Cheng 2009), and reducing serotonin levels (Zhou 2008);

  • evoking short-term increases in mu -opioid receptors binding potential, in multiple pain and sensory processing regions of the brain (Harris 2009);

  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz 1987, Zhao 2008);

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003)

  • improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which aids dispersal of swelling.

Frozen shoulder

How acupuncture can help

Acupuncture can reduce pain, inflammation, muscle and joint stiffness, and so may help in the treatment of frozen shoulder, by:

  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz, 1987, Zijlstra 2003, Zhao 2008, Cheng 2009);

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kim 2008, Kavoussi 2007, Zijlstra 2003);

  • enhancing local microcirculation, by increasing the diameter and blood flow velocity of peripheral arterioles (Komori 2009).


Gastrointestinal tract and digestion disorders

How acupuncture can help
In comparisons with Western drug treatments acupuncture has been found beneficial for a variety of gastrointestinal diseases: dyspepsia (Chen 2005), gastritis (Ren 2009; Gu 2009), ulcerative colitis (Mu 2007; Lee 2009), reflux (Journal of the National Medical Association 2008; Zhang 2010) and pancreatitis (Wang 2007).
Acupuncture may help in the treatment of GI tract disorders, by:

  • inhibiting gastric and duodenal motility by activating sympathetic nerves via spinal reflexes, and increasing motility via the vagus nerve and supraspinal reflexes (Chang 2001; Takahashi 2006; Sehn 2006; Yao 2006; Noguchi 2008);

  • altering acid secretion, and visceral pain (Takahashi 2006)

  • improving delayed gastric emptying (Xu 2006)

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors?(Zijlstra 2003)

  • stimulating areas in the brain that are involved in gastric perception (Zeng 2009)

  • inhibiting stress-induced pro-opiomelanocortin expression in the hypothalamus (Sun 2008)

  • increasing vasoactive intestinal peptide and nitric oxide in plasma, gastric mucosal and bulb tissues, and elevating expression of vasoactive intestinal peptide in antral smooth?? muscle (Shen 2006);

  • decreasing permeability of intestinal mucosa in patients with acute pancreatitis, and reducing accumulation of endogenous inflammatory mediators and vascular active substance in intestinal mucosa (Wang 2007).

Gout

How acupuncture can help

This Factsheet focuses on the evidence for acupuncture in the treatment of gout.

Overall, research has found: acupuncture combined with infrared irradiation is more effective in acute gouty arthritis than indomethacin, and provides a significant analgesic effect, while not reducing liver function (Zhou 2011); surround needling therapy is more effective and safer than allopurinol for the treatment of acute gouty arthritis (Xie 2009); electroacupuncture combined with local blocking (Liu 2008) or point-injection (Zou 2007) is an effective method for treating acute gouty arthritis, and can decrease blood uric acid levels; electroacupuncture has a better treatment effect than either allopurinol or probenecid, and there are no harmful effects on renal function in the treatment of patients with gout and renal insufficiency (Xie 2007); electroacupuncture is an effective treatment for acute gouty arthritis, and low frequency (2 Hz) electroacupuncture is more effective than higher frequencies (Zou 2006); and, acupuncture may exert good therapeutic effects on early gout complicated with renal damage (Ma 2004). Thus, the evidence so far indicates acupuncture to be more effective than medication and without serious side effects.

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress (Hui 2010) It has also be shown to reduce inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007).
Research has shown that acupuncture treatment may help relieve pain and prevent acute attacks of gout by:

  • Reducing the production of uric acid and promoting its excretion (Xie 2007);

  • Restoring the various metabolic pathways that are disturbed in individuals with gout (Wen 2011);

  • Reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007);

  • Increasing local microcirculation (Komori 2009);

  • Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);

  • Increasing the release of adenosine, which has antinociceptive properties (Goldman 2010).


Headache

How acupuncture can help

Evidence from the most up-to-date and highest quality systematic review showed that there are clinically relevant benefits of adding acupuncture to routine care and also a statistical advantage of 'true' acupuncture over sham interventions. Sun and Gan (2008) found acupuncture better than sham, and also better than medication, for headache intensity and frequency, but this was for a mixture of tension and migraine-types.

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress (Hui 2010)

Acupuncture may help to relieve tension-type headache by:

  • increasing endorphins (Han 2004) and neuropeptide Y levels (Lee 2009), which can help to combat negative affective states;

  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz, 1987; Zhao 2008; Cheng 2009);

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007);

  • increasing local microcirculation (Komori 2009), which aids dispersal of swelling.

Herpes

How acupuncture can help

Evidence from a systematic review of studies assessing the treatment of herpes zoster with acupuncture suggests that acupuncture therapy is effective for the condition.(Yu 2007) In a randomised controlled trial, electroacupuncture in combination with surround needling was found to be effective in facilitating crust formation and pain relief in patients with herpes zoster, and the effect was superior to that of medication.(Li 2009) Another randomised controlled trial found that acupuncture (surround needling) had a positive effect on cure rate in patients with herpes zoster, and that adding moxibustion to acupuncture improved the cure rate, and reduced the time to crust formation and the incidence of residual neuralgia.(Zhang 2007) (see Table below). There is very little research on acupuncture and shingles outside of China. Most of the trials to date are of low quality and the conclusions of the systematic review should be viewed in that light.

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress (Hui 2010)

Acupuncture may help to relieve symptoms in people with herpes zoster by:

  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz, 1987; Han 2004; Zhao 2008; Cheng 2009);

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007);

  • enhancing natural killer cell activities and modulating the number and ratio of immune cell types (Kawakita 2008);

  • increasing local microcirculation (Komori 2009), which aids dispersal of swelling.

HIV infection

How acupuncture can help

This factsheet focuses on the evidence for acupuncture in HIV. There are also factsheets on chronic pain, depression, neuropathic pain, gastrointestinal symptoms and palliative care.
Two randomised controlled trials found that there could potentially be synergistic effects of acupuncture and relaxation, one for treating GI symptoms and one to improve quality of life. (Chang 2011; Chang 2007) Another randomised controlled trial found that acupuncture resulted in an improvement in peripheral neuropathy in patients with HIV/AIDS. (Shiflett 2011) The results of two open studies also suggest a positive effect of acupuncture on neuropathic pain (Phillips 2004; Galantino 1999), while other open and quasi-controlled studies have found that acupuncture may help with facial pain (Zhou 2008), diarrhoea (Anastasi 2003) and sleep disturbance (Phillips 2001). Finally, one study found that moxibustion appeared to increase total lymphocyte count. (Wang 2007)

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.

Research has shown that acupuncture treatment may specifically help to relieve symptoms of HIV infection by:

  • Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);

  • Increasing the release of adenosine, which has antinociceptive properties (Goldman 2010);

  • Improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which aids dispersal of swelling;

  • Reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007);


Infertility ART

How acupuncture can help

Most clinical trials to date suggest that acupuncture may be useful in the embryo transfer stage of in vitro fertilisation, and results in an increased pregnancy rate and a greater number of live births (Cheong 2008, Manheimer 2008, Kong 2009, Chen 2009, Smith 2006, Westergaard 2006). ?

Acupuncture may help in the treatment of infertility by:

  • regulating fertility hormones - stress and other factors can disrupt the function of the hypothalamic pituitary-ovarian axis (HPOA). Acupuncture promotes the release of beta-endorphin in the brain, which regulates gonadatrophin releasing hormone from the hypothalamus, follicle stimulating hormone from the pituitary gland, and oestrogen and progesterone levels from the ovary (Anderson 2007).

  • increasing blood flow to the reproductive organs (Ho 2009, Anderson 2007), which can improve the thickness of the endometrial lining, so increasing the chances of embryo implantation.

  • increasing egg production (Jin 2009) and improving oocyte quality (Chen 2009), which could increase the chance of fertilisation.

  • enhancing luteal function (Huang 2009)

  • regulating follicle stimulation hormone-receptor expression (Jin 2009).

  • normalising cortisol and prolactin levels on IVF medication days (Magarelli 2008); reducing stress (Anderson 2007)

  • promoting embryo implantation (Liu 2008).

Insomnia

How acupuncture can help

Reviews are consistent in showing that most trials have found acupuncture (or acupressure or related procedures) to be significantly more effective than hypnotic drugs (usually benzodiazepines), no treatment, or sham acupuncture (Sun 2010, Cao 2009, Yeung 2009, Lee 2008, Cheuk 2007). Meta-analysis supports these conclusions. Nevertheless, reviewers have been cautious in their recommendations because of the poor methodological quality of most trials; rigorous, large scale studies are needed to address this. There are now substantial numbers of more recent (published subsequent to the reviews' data collection) randomised trials with positive results, though not for every sleep measure used in every trial (Luo 2010, Reza 2010, Yeung 2009, Lee 2009a, Huang 2009, and others). On the evidence that we have, given that acupuncture appears to be at least as effective as existing conventional drugs, without their level of side effects, it could be considered as one of the therapeutic options for insomnia. (See table overleaf for details).

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for insomnia and anxiety (Hui 2010).

Research has shown that acupuncture treatment may specifically be of benefit in people with insomnia by:

  • increasing nocturnal endogenous melatonin secretion (Spence et al 2004).

  • stimulating opioid (especially b-endorphin) production and ?-opioid receptor activity (Cheng et al 2009).

  • increasing nitric oxide synthase activity and nitric oxide content, helping to promote normal function of brain tissues, which could help to regulate sleep (Gao et al 2007).

  • increasing cerebral blood flow (Yan 2010)

  • reducing sympathetic nervous system activity, hence increasing relaxation (Lee 2009a)

  • regulating levels of neurotransmitters (or their modulators) such as serotonin, noradrenaline, dopamine, GABA and neuropeptide Y; hence altering the brains's mood chemistry to help to increase relaxation and reduce tension (Lee 2009b; Samuels 2008; Zhou 2008).

Acupuncture can be safely combined with conventional medical treatments for insomnia, such as benzodiazepines, helping to reduce their side effects and enhance their beneficial effects (Cao et al 2009).

Irritable bowel syndrome (IBS)

How acupuncture can help

Research has shown that acupuncture treatment may benefit IBS symptoms by:

  • Providing pain relief (Pomeranz 1987).

  • Regulating the motility of the digestive tract (Yin 2010, Chen 2008).

  • Raising the sensory threshold of the gut. Various possible mechanisms have been identified, involving spinal nerves and NMDA receptors and a range of neurotransmitters (Xu 2009, Ma 2009, Tian 2008, Tian 2006, Xing 2004). A lowered threshold to bowel pain and distention are hallmarks of IBS.

  • Increasing parasympathetic tone (Schneider 2007b). Stress activates the sympathetic nervous system, which can stimulate colon spasms, resulting in abdominal discomfort. In people with IBS, the colon can be oversensitive to the smallest amount of conflict or stress. Acupuncture activates the opposing parasympathetic nervous system, which initiates the relaxation or 'rest and digest' response.

  • Reducing anxiety and depression (Samuels 2008). The distress provoked by IBS symptoms can lead to a vicious cycle of anxiety-pain-anxiety, while the embarrassing nature of the condition can lead to feelings of depression. Acupuncture can alter the brain's mood chemistry, increases production of serotonin and endorphins (Han 2004), helping to combat these negative affective states.

There is consistent evidence that a course of acupuncture improves IBS symptoms and general wellbeing (Anastasi 2009, Trujillo 2008, Reynolds 2008, Schneider 2007b, Xing 2004, Lu 2000), though there are arguments about the extent to which the effect is placebo-related (Lembo 2009, Schneider 2007a, Lim 2006, Forbes 2005). As yet there is no satisfactory placebo/sham intervention for acupuncture so this is still a matter for conjecture. There are plausible physiological explanations for acupuncture's effects (see above) and it can promote mechanisms not seen with sham treatments (Schneider 2007b).

Acupuncture can be safely and effectively combined with Western biomedicine, and other treatments such as relaxation exercises, herbal medicine and psychotherapy. In addition to offering acupuncture and related therapies, acupuncturists will often make suggestions as to dietary and other lifestyle changes that may be helpful in combating IBS symptoms. Working with a supportive therapist can also help people suffering from IBS to change their negative health beliefs and improve their coping mechanisms, which can have a positive influence on both mood and symptoms.


Kidney stones

How acupuncture can help

This factsheet focuses on the evidence for acupuncture for kidney stones and gallstones.

Most of the randomised controlled trials (RCTs) in this area relate to acupuncture used as an adjunct to lithotripsy, and there is evidence that it may reduce anxiety and sedative/analgesic drug requirements (Miyaoka 2009). It was found to provide more effective analgesia than pethidine and diazepam in one trial (Hodzic 2007) and to be at least as good as midazolam in another (Resim 2005). Likewise, acupuncture may be a useful addition for cholecystectomy (Gu 2010).

However, the extent to which it can benefit people with kidney or gall stones outside of assisting with these biomedical procedures has scarcely been addressed in the research literature. One controlled study showed a significant advantage for electroacupuncture over medication for stones in the upper urinary tract (Lin 2005). Others have found it to be beneficial when compared to Chinese herbal medicine (Song 2006; Xuemei 2006). In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.

Research has shown that acupuncture treatment may specifically help in the management of kidney stones and gallstones by:

  • Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);

  • Increasing the release of adenosine, which has antinociceptive properties (Goldman 2010);

  • Improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which aids dispersal of swelling;

  • Reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007);

  • Increasing the distribution of cholecystokinin - and vasoactive intestinal peptide -containing cells in duodenum and the sphincter of Oddi, thus improving biliary tract motility (Kuo 2005).


Male infertility

How acupuncture can help

Some clinical trials suggest that acupuncture improves sperm motility (Dieterle 2009), increases sperm count (Siterman 2009, Siterman 2001), improves sperm quality (Pei 2005; Gurfinkel 2003) and has a beneficial effect on psychogenic erectile dysfunction (Engelhardt 2003) (see Table overleaf). The research results are promising but still at a preliminary stage in terms of numbers and quality of studies.

Acupuncture may help in the treatment of male infertility (Stener-Victorin 2010), by:

  • lowering scrotal temperature (Siterman 2009);

  • enhancing local microcirculation, by increasing the diameter and blood flow velocity of peripheral arterioles (Komori 2009);

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors?(Zijlstra 2003)

  • by improving sperm maturation in the epididymis, increasing testosterone levels, and reducing liquid peroxidation of sperm?(Crimmel 2001)

Menopausal symptoms

How acupuncture can help

Acupuncture may help reduce symptoms of the menopause and perimenopause by:

  • regulating serum estradiol, follicle stimulating hormone and luteotrophic hormone (Xia 2008);
  • increasing relaxation and reducing tension (Samuels 2008). Acupuncture can alter the brain's mood chemistry, reducing serotonin levels?(Zhou 2008) and increasing endorphins (Han, 2004) and neuropeptide Y levels (Lee 2009), which can help to combat negative affective states.
  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz, 1987, Zijlstra 2003, Cheng 2009).

Migraines

How acupuncture can help

There have now been many controlled trials of acupuncture for migraine, with some large, high-quality ones in recent years. The results of the latest reviews are quite consistent: acupuncture is significantly better than no treatment/basic care for managing?migraine, and appears to be at least as effective as prophylactic drug therapy, with few contraindications or unpleasant side effects (Linde 2009, Wang 2008, Sun 2008, Scott 2008).? Acupuncture has a similar or slightly better effect than sham procedures, which themselves can perform as well as conventional drugs, indicating that sham acupuncture is not an inactive placebo but a contentious alternative intervention. Acupuncture has been found to be cost-effective (Witt 2008; Wonderling 2004). As well as prevention it may also be used to alleviate symptoms in acute attacks (Li 2009). There is preliminary qualitative evidence from patients that acupuncture can increase coping mechanisms as well as relieve migraine symptoms (Rutberg 2009).

Migraine is thought to begin as an electrical phenomenon in the cerebrum that then affects blood vessels, biochemistry, and causes neurogenic inflammation.

Acupuncture can help in the treatment of migraine by:

  • Providing pain relief - by stimulating nerves located in muscles and other tissues, acupuncture leads to release of endorphins and other neurohumoral factors and changes the processing of pain in the brain and spinal cord (Zhao 2008, Zijlstra 2003, Pomeranz, 1987)

  • Reducing inflammation - by promoting release of vascular and immunomodulatory factors (Kim 2008, Kavoussi 2007, Zijlstra 2003).

  • Reducing the degree of cortical spreading depression (an electrical wave in the brain associated with migraine) and plasma?levels of calcitonin gene-related peptide and substance P (both implicated in the pathophysiology of migraine) (Shi 2010).

  • Modulating extracranial and intracranial blood flow (Park 2009).

  • Affecting serotonin (5-hydroxytriptamine) levels in the brain (Zhong 2007). (Serotonin may be linked to the initiation of migraines; 5-HT agonists (triptans) are used against acute attacks.)

Multiple Sclerosis

How acupuncture can help

This Factsheet focuses on the evidence for acupuncture in MS.
There has been very little research published. One systematic review, which summarised and evaluated the available evidence of acupuncture for neurological diseases concluded that more rigorous trials are warranted to establish acupuncture's role in MS. (Lee 2007) A randomised controlled trial that compared the effects of 2 types of acupuncture in 14 patients with secondary progressive MS found that minimal acupuncture resulted in greater improvement than Chinese medical acupuncture for psychological health: all other aspects were similar (Donnellan 2008). An uncontrolled open study, which looked at whether electroacupuncture diminishes voiding symptoms and improves quality of life in patients with MS and overactive bladder and urge incontinence, found that it may have a useful role in patients with MS and mild bladder dysfunction who do not wish to take medication or are unable to because of side effects (Tjon Eng Soe 2009).

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.

Research has shown that acupuncture treatment may specifically help to relieve symptoms of multiple sclerosis by:

  • reducing numbers of inflammatory and CD4 T cells. This accompanied improved paralytic symptoms in a rat model of MS (Kim 2012);

  • promoting NT-3 (a protein growth factor that supports neuronal survival) expression, increasing the cell number and differentiation of endogenous oligodendrocyte precursor cells, and causing remyelination and functional improvement of the demyelinated spinal cord (Huang 2011);

  • acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);

  • increasing the release of adenosine, which has antinociceptive properties (Goldman 2010;

  • improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which aids dispersal of swelling;

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007).


Nausea and vomiting

How acupuncture can help

The best evidence for acupuncture's effectiveness is with postoperative nausea and vomiting (PONV) (Ezzo 2006a). The latest systematic review, based on 40 trials and nearly 5,000 patients, found acupuncture to be significantly better than sham treatment and at least as good as anti-emetic drugs, with minimal side-effects (Lee 2009). Trials published since this review gathered its data have also been consistently positive: acupressure at P6 (Soltani 2010), acupoint injection of droperidol at P6 (Zhu 2010), 24-hour acupoint stimulation (Frey 2009), acupuncture at several points (Ayoglu 2009), acupuncture at P6 (Puyang 2009, Frey 2009) and ear acupuncture (Sahmaddini 2008). There is one less consistently favourable review but that looked specifically at caesarean delivery under neuraxial anaesthesia (6 trials only): (Allen 2008).

For chemotherapy-induced nausea and vomiting, there is also substantial evidence supporting acupuncture and associated procedures, although it is not as consistent as that for PONV. The latest systematic review (Ezzo 2006b) is now several years old. It found that electro- (but not manual) acupuncture reduced the incidence of acute vomiting and self-administered acupressure appears to have a protective effect for acute nausea and can readily be taught to patients. Subsequent individual trials of acupuncture or electroacupuncture (Yang 2009; You 2009; Sima 2009; Gottschling 2008) have all reported significant benefits, while those for acupressure applied using a wristband have been mixed (Jones 2008; Molassiotis 2007; Shin 2006).?
Acupuncture, electroacupuncture or acupressure have been used successfully as treatments for nausea and vomiting arising in various other circumstances, for example opioid-induced (Zheng 2008), radiotherapy-induced (Roscoe 2009; Bridge 2003), and post-myocardial infarction (Dent 2003).

It is characteristic of virtually all the Western trials of acupuncture for nausea and vomiting that they have used just the one point, P6. While this point is certainly strongly indicated for these symptoms, and appears to have a marked specific effect, it is by no means the only candidate; in traditional practice a mixture of different points would usually be employed, related to individual patient characteristics.

See Table overleaf for further details of the cited studies.

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules (Han 2004; Zhou 2008; Lee 2009). The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being (Pomeranz, 1987; Zhao 2008; Samuels 2008; Cheng 2009).. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation (Hui 2010).

Acupuncture may help to alleviate nausea and vomiting by:

  • regulating gastric myo-electrical activity (Streitberger 2006)

  • modulating the actions of the vagal nerve and autonomic nervous system (Huang2005)

  • reducing vasopressin-induced nausea and vomiting and suppressing retrograde ??peristaltic contractions (Tatewaki 2005)

  • regulating vestibular activities in the cerebellum (Streitberger 2006)

Neck pain

How acupuncture can help

Acupuncture can help relieve neck pain by:

  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz 1987, Zhao 2008);

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003);

  • improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which aids dispersal of swelling.

Neuropathic pain

How acupuncture can help

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.

Research has shown that acupuncture treatment may specifically help to relieve neuropathic pain by:

  • Reducing hypersensitivity induced by spinal nerve ligation, an effect dependent on the opioid system (Cidral-Filho 2011);

  • Inhibiting paclitaxel-induced allodynia/hyperalgesia through spinal opioid receptors (Meng 2011);

  • Influencing the neurotrophic factor signalling system, which is important in neuropathic pain (Dong 2006).

  • Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);

  • Increasing the release of adenosine, which has antinociceptive properties (Goldman 2010);

  • Improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which aids dispersal of swelling;

  • Reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007);


Obesity

How acupuncture can help

This Factsheet focuses on the evidence for acupuncture in the management of obesity.

Three systematic reviews have shown benefits with acupuncture in the management of obesity. One found it to be more effective than placebo or lifestyle modifications and as effective as medication, but with fewer side effects (Sui 2012). Another found it to be safe and effective in the treatment of obesity and possibly more effective than medication (Lui 2009). The third concluded that acupuncture was effective for the treatment of obesity (Cho 2009). These results are promising but not conclusive, as many of the component trials have been of poor quality. Given the scale of the problem, and the shortcomings of conventional treatment options for obesity, an investment in large, high quality acupuncture trials would be welcome.

Randomised controlled trials published recently have also shown benefits with acupuncture in patients with obesity. In simple obesity, acupuncture has been found to reduce BMI more than placebo (Tong 2011), to provide increased weight loss when added to weight loss programmes with dietary measures and aerobic exercise (Yang 2010; Buevich 2010). Electroacupuncture has been shown to improve body composition in postmenopausal women with obesity (Lui 2010 and, in combination with moxibustion, has been shown to be more effective than sibutramine (Zhu 2010. Auricular acupuncture has been found to have a potential beneficial effect on obesity-related hormone peptides (Hsu 2009).

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.

Research has shown that acupuncture treatment may specifically help to cause weight loss and reduce obesity by:

  • Modulating serum immunoglobulin G (Cabioglu 2007);

  • Lowering serum leptin and increasing adiponectin (Luo 2007; Baocun 2006);

  • Lowering serum glucose and increasing insulin and c-peptide levels (Cabioglu 2006);

  • stimulating alpha-melanocyte stimulating hormone expression and release (Fei 2011);

  • enhancing the expression of peroxisome proliferator- activated receptor gamma mRNA in adipose tissues ( PPARG is a hormone receptor gene involved in fat cell differentiation and function), activating the activities of lipoprotein lipase and hepatic lipase, and decreasing the levels of total cholesterol and low-density lipoprotein cholesterol in serum? (Gao 2011);

  • reducing blood lipids (triglycerides, total cholesterol, low-density lipoprotein cholesterol), fasting blood glucose levels, and expression of monocyte chemoattractant protein-1 mRNA and tumour necrosis factor -alpha mRNA (both are cytokines implicated in adipose tissue regulation),? and increasing high-density lipoprotein-cholesterol (Yu 2011);

  • up-regulating obestatin expression in the hypothalamus (Kong 2010).

Obstetric (pregnancy and childbirth)

How acupuncture can help

An overview of systematic reviews and randomised controlled trials across the whole area of pregnancy found evidence that acupuncture may assist with the management of some complaints, though more studies are needed (Smith 2009).

Systematic reviews of randomised and quasi-randomised controlled trials suggest that acupuncture may help to relieve pain during labour (Cho 2010; Smith 2006). The later review found that acupuncture was superior to conventional analgesia but not, or marginally, better than minimal (sham) acupuncture. Given that 'sham' acupuncture interventions are not inert placebos the effect of 'real' acupuncture may be under-estimated in such trials, and non-superiority should not necessarily be taken at face value (Lundeberg 2009). Since that review was compiled there have been further trials supporting the efficacy of electroacupuncture (Ma WZ 2010), moxibustion (Ma SX 2010) and acupressure (Hjelmstedt 2010) though the size (and clinical significance) of the effect is still to be confirmed.

Several systematic reviews have found that moxibustion has a positive effect in correcting breech presentation (Vas 2009; Li 2009; Van den Berg 2008).

For back and pelvic pain there is a systematic review (Ee 2008) and one subsequent RCT (Wang 2009) indicating that acupuncture may provide effective pain relief. In another recent study (Eldon 2008) acupuncture was significantly superior to sham for functional ability but not pain relief (see above for comments on sham acupuncture comparisons).

A systematic review of acupuncture for labour induction suggested that it could be beneficial.

There is evidence in favour of acupuncture for depression (Manber 2010), emotional problems in general (da Silva 2007) and dyspepsia (da Silva 2009).
Acupuncture is relatively safe with no records of serious adverse events in the pregnancy-related systematic reviews (Cho 2010; Lim 2009; Vas 2009; Ee 2008).
See Table overleaf for further details of the cited studies.

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation (Hui 2010).

In pregnant women, acupuncture may help to relieve pain (e.g. back pain, labour pain), improve mood and reduce anxiety, alleviate dyspepsia, and turn a fetus who is breech by:

  • increasing relaxation and reducing tension (Samuels 2008). Acupuncture can alter the brain's mood chemistry, reducing serotonin levels (Zhou 2008), and increasing endorphins (Han, 2004) and neuropeptide Y levels (Lee 2009), which can help to combat negative affective states.

  • ?stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz, 1987; Zhao 2008;?Cheng 2009);

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors?(Zijlstra 2003; Kavoussi 2007);

  • ?increasing cortico-adrenal secretion, placental estrogens, and changes in prostaglandin levels, which leads to raised basal tone of the uterus and enhanced movement of the fetus, thus making version more likely (Van den Berg 2008).


Palliative care

Palliative care is the active holistic care of patients with advanced progressive illness, such as those with advanced cancer, end-stage renal disease, AIDS, and chronic obstructive pulmonary disorder (COPD)(WHO 2002). Management includes treatments for pain and other symptoms (e.g. fatigue, nausea and vomiting, breathlessness, anxiety, depression, vasomotor symptoms, xerostomia), as well as the provision of psychological, social and spiritual support (NICE 2004). Up to 457,000 people in the UK need good palliative care services every year but around 92,000 people are not being reached (Hughes-Hallett 2011).


How acupuncture can help

Most research so far has focused on helping the side-effects of orthodox cancer treatments, and on relieving pain. First, we consider those symptoms where there has been enough research to merit it being systematically reviewed.

Pain
Several randomised controlled trials (RCTs) have indicated that acupuncture may relieve pain in palliative settings and in addition it may reduce the need for cancer pain drugs (Lu 2008). One recent systematic review found (limited) evidence that acupuncture may provide long-term pain relief in patients with cancer (Paley 2011) and the most recent trials have strengthened the evidence (refer to the 'Acupuncture for Cancer Care' Fact Sheet, 2011).

Most research on acupuncture for chronic pain has been carried out in primary and secondary care with musculoskeletal conditions and headache, though also to some extent for visceral pain. Recent studies are demonstrating an effect over and above placebo (Hopton 2010). Palliative care patients, too, frequently suffer from non-cancer-specific pain and would be expected to benefit similarly from acupuncture.

Pain arising indirectly from cancer treatments may also be addressed with acupuncture, for example for chemotherapy- induced neuropathy (Donald 2011). Patients with HIV-associated neuropathic pain may also benefit (refer to the 'Acupuncture for Neuropathic Pain' Fact Sheet, 2012). Filshie (2003) reported that pain from cancer treatments is likely to respond better, and for longer, that that from the disease itself; nevertheless, there are still benefits possible for patients with late-stage cancer.

Dry mouth (xerostomia)
A systematic review found possible benefits with acupuncture for radiotherapy-induced xerostomia (O'Sullivan 2010). Not all the inter-group differences were significant but this is typical in trials comparing acupuncture with sham acupuncture, for the latter is commonly viewed as being an active treatment itself, not a placebo, and hence may underestimate the effects of the therapy (Lundeberg 2011; Sherman 2009; Paterson 2005).The RCTs to date are few in number and small in size. Although they have produced encouraging results, and are supported by observational studies (for example, Meidell 2009), larger trials are required to achieve more robust evidence. Acupuncture may also help with xerostomia dysphagia (swallowing difficulty) in late-stage palliative care (Filshie 2003).

Nausea and vomiting
Three systematic reviews found that moxibustion or acupuncture can help relieve chemotherapy-induced nausea and vomiting?(Lee 2010; Chao 2009; Ezzo 2006), especially in acute situations, and even self-administered acupressure may be effective.

Breathlessness
Systematic reviews found low strength evidence that acupuncture/acupressure is helpful for breathlessness, with most of the studies on patients with COPD (Bausewein 2008). Semi-permanent indwelling needles have been used to prolong the effect and to give patients some control, by massaging them (Filshie 2003).

Hot flushes
The vasomotor symptoms brought on by chemotherapy treatment for breast and prostate cancer may be alleviated with acupuncture, though the evidence is not yet conclusive (Lee 2009a, 2009b; see Cancer Care Fact Sheet for details of more recent trials). Filshie (2005) provides details of the protocol used in a specialist UK cancer centre (which again includes self-treatment) together with positive audit results.

Other symptoms
Several pilot RCTs have found acupuncture to benefit patients with chemotherapy-related?fatigue?(Lu 2008). Acupuncture has also provided an alternative method for managing fatigue in patients with end-stage renal disease (Tsay 2004). Two recent observational studies have provided positive preliminary findings for?lymphoedema?(Cassileth 2011; de Valois 2011). Also, in cancer patients, recent trials have suggested benefit for?insomnia and depression?(Feng 2011). Filshie (2011) has reported a wide range of other applications, especially for side effects of radiotherapy.

HIV patients may find adjunctive acupuncture useful for?gastrointestinal side-effects of anti-retroviral therapy?(Chang 2011), for?sleeplessness?(Philips 2001) and for?neuropathic pain?(discussed above).

Holistic care
Most patients in palliative care do not present with single symptoms and it may be advantageous to address them globally (Filshie 2011; Lim 2011). Further, although symptom control may be the main focus palliative care also emphasises patient dignity, autonomy and self-efficacy (Kauffman 2008; Lu 2008). Broad holistic benefits, covering multiple physical and mental symptoms and self-empowerment outcomes are characteristic of acupuncture (Rugg 2011).

Reviews of the evidence for acupuncture in palliative care have concluded that it is a promising adjunctive therapy (and potentially cost-effective).

A number of observational pilot studies in advanced cancer and haemodialysis populations have demonstrated change over a wide range of symptoms, alongside improved quality of life (Dean-Clower 2010), safety (Kim 2011), user endorsement of the service (Johnstone 2002), and the capability to stay living at home through the terminal stages (Takahashi 2009). A small RCT of acupuncture compared to nurse-led care in patients with incurable cancer reported global benefits without significant side-effects or other tolerance issues (Lim 2011). Also, most symptom improvement was still evident 6 weeks after the end of treatment (though in practice, a regime of follow-on maintenance sessions would usually be advisable given the nature of the disease). For HIV patients with peripheral neuropathy RCT results indicated reduced attrition and mortality with acupuncture, though the effects on pain were inconclusive (Shiflett 2011).

Mechanisms
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.

Research has shown that acupuncture treatment may specifically benefit symptoms associated with palliative care by:

  • Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009)

  • Regulating neurotransmitters (or their modulators) and hormones such as serotonin, noradrenaline, dopamine, GABA, neuropeptide Y and ACTH; hence altering the brain's mood chemistry to help to combat negative affective states (Cheng 2009; Zhou 2008;

  • Increasing the release of adenosine, which has antinociceptive properties (Goldman 2010)

  • Improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which aids dispersal of swelling

  • Stimulating production of endogenous opioids that affect the autonomic nervous system, promoting relaxation and reduced stress Arranz 2007)

  • Reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003)

  • Reversing stress-induced changes in behaviour and biochemistry (Kim 2009)

  • Increasing levels of T lymphocyte subsets such as CD(3), CD(4), and CD(8), as well as Natural Killer cells (Zhao 2010)

  • Relieving nausea and vomiting via central opioid pathways (Tatewaki 2005), regulating gastric myo-electrical activity (Streitberger 2006), modulating the actions of the vagal nerve and autonomic nervous system (Huang 2005), and regulating vestibular activities in the cerebellum (Streitberger 2006)

  • Enhancing levels of vasoactive intestinal polypeptide and calcitonin gene-related peptide (O'Sullivan 2010), which may relieve xerostomia and hot flushes

Parkinson's disease

How acupuncture can help

This Factsheet focuses on the evidence for acupuncture in the management of patients with Parkinson's disease.
There have been two systematic reviews on the subject, both of which found evidence that acupuncture may be effective for treating idiopathic Parkinson's disease, but also concluded that more (and larger) high quality studies are needed to confirm this. (Lam 2008; Lee 2008).

There have been several randomised controlled trials published since these systematic reviews. In two studies acupuncture (Mei 2010) or acupuncture plus Chinese herbs (Huang 2009) were at least as good as orthodox medication. Also, adjunctive acupuncture has been found to improve the therapeutic effect of drugs alone (Ren 2008, Chang 2008). In one trial both standard and bee venom acupuncture (i.e. injecting dilute bee venom into acupuncture points) were superior to a no-treatment control (Cho 2012). These studies also suggest that an adjunctive acupuncture regime could allow lower doses of medication to be used, and hence fewer side effects. ?

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.

Research has shown that acupuncture treatment may specifically help in the management of Parkinson's disease by:

  • affecting neural mechanisms involving the basal ganglia-thalamocortical circuit of the brain (Chae 2009);

  • increasing cerebral blood flow in the most affected hemisphere (Huang 2010);

  • improving cerebral glucose metabolism (Huang 2009);
    enhancing synaptic dopamine availability, which may play a critical role in motor function improvement (Kim 2011a);

  • attenuating neuronal damage and increasing the number of neurons in the substantia nigra (Yang 2011, Wang 2010);

  • activating the PI3K/Akt signalling pathway (and hence regulating cellular survival) in the substantia nigra, (Kim 2011b);

  • mobilising the antioxidant defence system (via substances such as superoxide dismutase) to protect neurons in the nigrostriatal system (Wang 2011, Yu 2010)

  • acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);

  • increasing the release of adenosine, which has antinociceptive properties (Goldman 2010)

PCOS (polycystic ovarian syndrome)

How acupuncture can help

A review concluded that acupuncture is a safe and effective treatment for PCOS, and may have a role: increasing blood flow to the ovaries, reducing ovarian volume and the number of ovarian cysts, controlling hyperglycaemia by increasing insulin sensitivity and decreasing blood glucose and insulin levels, reducing cortisol levels and assisting in weight loss and anorexia (Lim 2010). Randomised controlled trials have been published since the systematic review. One trial found that acupuncture can improve the clinical pregnancy rate in patients with PCOS undergoing IVF-ET (Cui 2011).?Another found that abdominal acupuncture treatment can improve the endocrine and metabolic function of patients with obesity-type PCOS (Lai 2010). A third found low-frequency electroacupuncture and physical exercise improved hyperandrogenism and menstrual frequency more effectively than no intervention in women with PCOS, and that it was superior to physical exercise (Jedel 2011).

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.

Research has shown that acupuncture treatment may specifically help with symptoms of PCOS by:

  • impacting on beta-endorphin production, which may affect gonadotropin-releasing hormone (GnRH) secretion (Lim 2010; Stener-Victorin 2009;?Feng 2009; Manneras 2009);

  • a regulatory effect on follicle stimulation hormone (FSH), luteinising hormone (LH) and androgens (Lim 2010; Feng 2009);

  • modulating the activity of the sympathetic nervous system and improving blood flow to the ovaries (Stener-Victorin 2006, 2009);

  • regulating steroid hormone/peptide receptors (Feng 2012);

  • downregulating the expressions of serum levels of testosterone and oestradiol (Zang 2009);

  • controlling hyperglycaemia by increasing insulin sensitivity and decreasing blood glucose and insulin levels (Lim 2010);

  • acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);

  • increasing the release of adenosine, which has antinociceptive properties (Goldman 2010), and;

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007).

Post-operative pain

Systematic reviews suggest that acupuncture and ear acupuncture are useful adjunctive treatments for post-operative pain management (Sun 2008; Usinchenko 2008). Several recent randomised controlled trials have found acupuncture and electroacupuncture to reduce post-operative pain, the use of patient-controlled analgesia (opioids), and post-operative nausea and vomiting (Salmeddini 2010; Larson 2010; Parthasarathy 2009; Wu 2009; Grube 2009; Wong 2006).

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety (Wu 1999).

Acupuncture may help relieve post-operative pain by:

  • altering the brain's chemistry, increasing endorphins (Han 2004) and neuropeptide Y levels (Lee 2009; Cheng 2009), and reducing serotonin levels (Zhou 2008).

Post-traumatic stress disorder

How acupuncture can help

This factsheet looks at the evidence for acupuncture in the treatment of PTSD. There are related factsheets on anxiety, stress and depression.

There are preliminary positive findings for acupuncture in the treatment of chronic anxiety associated with PTSD. A systematic review of acupuncture for PTSD found that the evidence of effectiveness is encouraging (Kim 2013): all four reviewed randomised controlled trials (RCTs) indicated that acupuncture was equal to or better than orthodox treatments, or that it added extra effect to them when used in combination. Three of the four are Chinese studies that used earthquake survivors and one similar RCT (Wang 2012) was too recent to be included in the review. It found that both electroacupuncture and paroxetine resulted in significantly improved scores for PTSD, but that the improvement was greater with electroacupuncture. There is also some evidence that the acupuncture effects may continue for at least a few months after the treatment course is finished (Hollifield 2007).

A review that looked at the effects of combining brief psychological exposure with the manual stimulation of acupuncture points in the treatment of PTSD and other emotional conditions found evidence suggesting that tapping on selected points during imaginal exposure quickly and permanently reduces maladaptive fear responses to traumatic memories and related cues (Feinstein 2010).

Kim's review (Kim 2013) also included two uncontrolled trials (they too had positive outcomes). A more recent uncontrolled pilot study found that acupuncture appeared to be a therapeutic option in the treatment of sleep disturbance and other psycho-vegetative symptoms in traumatised soldiers (Eisenlohr 2012).

Although more high quality trials are needed to substantiate these results, the overall evidence does lie promisingly in a positive direction, and, given the very low level of side effects and lack of demonstrably superior outcomes from other interventions, acupuncture could be considered as one possible therapeutic option alongside the existing repertoire. (See table overleaf).

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.

Research has shown that acupuncture treatment may specifically benefit anxiety disorders and symptoms of anxiety and stress by:

  • Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Hui 2010);

  • Regulating levels of neurotransmitters (or their modulators) and hormones such as serotonin, noradrenaline, dopamine, GABA, neuropeptide Y and ACTH; hence altering the brain's mood chemistry to help to combat negative affective states (Lee 2009; Zhou 2008);

  • Stimulating production of endogenous opioids that affect the autonomic nervous system (Arranz 2007). Stress activates the sympathetic nervous system, while acupuncture can activate the opposing parasympathetic nervous system, which initiates the relaxation response;

  • Reversing pathological changes in levels of inflammatory cytokines that are associated with stress reactions (Arranz 2007);

Premenstrual syndrome (PMT)

How acupuncture can help

A systematic review (Cho 2010) located ten randomised controlled trials and found some evidence to suggest acupuncture reduces PMS symptoms.

Acupuncture may help reduce symptoms of PMS by:

  • increasing relaxation and reducing tension (Samuels 2008). Acupuncture can alter the brain's mood chemistry, reducing serotonin levels (Zhou 2008) and increasing endorphins (Han, 2004) and neuropeptide Y levels (Lee 2009), which can help to combat negative affective states.

  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz, 1987, Zijlstra 2003, Cheng 2009);

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors Kavoussi 2007, Zijlstra 2003).

Puerperium (After birth care)

How acupuncture can help

One systematic review of various treatments for breast engorgement during lactation (Manges 2010) located one eligible and analysable acupuncture study (Kvist 2007), and found that, compared to women receiving routine care, women receiving acupuncture had greater improvements in symptoms in the days immediately following treatment. The original study authors concluded that acupuncture plus care interventions such as correction of breast feeding position and babies' attachment to the breast, might be more effective and less invasive than oxytocin nasal spray for inflammatory symptoms of the breast, however, the evidence is still very much at a preliminary stage.

In other randomised controlled trials, acupuncture and electro-acupuncture have been shown to delay the time to requesting pain relief medication after caesarean section, and to decrease the patient-controlled analgesia doses used within the first 24 hours (Wu 2009); both auricular acupressure using press seeds (Zhou 2009) and electroacupuncture (Wang 2007) have been found to have some efficacy in hypogalactia.? [See Table below]

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation (Hui 2010)

Acupuncture may increase milk production, help relieve pain (e.g. back pain, headache, pain in the perineum), and improve mood and reduce anxiety in women who have recently given birth by:

  • increasing prolactin levels (Wang 2007);

  • altering the brain's chemistry (Samuels 2008), increasing endorphins (Han 2004) and neuropeptide Y levels (Lee 2009; Cheng 2009), and reducing serotonin levels (Zhou 2008);

  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz 1987, Zhao 2008);

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003).


Raynaud's

How acupuncture can help

An uncontrolled study found that auricular electroacupuncture appears to reduce symptoms by reducing the frequency and severity of attacks in primary Raynaud's phenomenon, but not to influence skin perfusion and skin temperature (Schlager 2011).
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.

Research has shown that acupuncture treatment may specifically help to relieve the symptoms of Raynaud's by:

  • Increasing local microcirculation (Komori 2009);

  • Regulating endothelium-derived vasoconstrictors (endothelin-1) and vasodilators (calcitonin gene-related peptide, nitric oxide and nitric oxide synthase) (Wang 2011a; Wang 2011b; Pan 2010; Kim 2006);

  • Reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007)

  • Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);
    Increasing the release of adenosine, which has antinociceptive properties (Goldman 2010).

Rheumatoid arthritis

How acupuncture can help

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress (Hui 2010) It has also been shown to reduce inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007).

Acupuncture treatment may help to relieve pain and improve function in patients with rheumatoid arthritis by:

  • decreasing the proinflammatory cytokines IL-1 and IL-6 and increasing the inhibitory cytokines?IL-4 and IL-10 (Ouyang 2010);

  • inducing vasoactive intestinal peptide expression, an anti-inflammatory neuro-peptide (He 2011);
    inhibiting the function of synovial mast cells (which are substantially involved in the initiation of inflammatory arthritis) (He 2010);

  • upregulating plasma adrenocorticotropic hormone, downregulating serum cortisol levels and synovial nuclear factor-kappa B p 65 immunoactivity, and restoring the?hypothalamus-pituitary-adrenal axis (HPAA) (Gao 2010);

  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz 1987; Han 2004; Zhao 2008; Cheng 2009);

  • increasing local microcirculation (Komori 2009), which aids dispersal of swelling.


Sciatica

How acupuncture can help

There is substantial research to show that acupuncture is significantly better than no treatment and also at least as good, if not better than, standard medical care for back pain (Yuan 2008, Furlan 20080).

Acupuncture can help relieve back pain and sciatica by:

  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz 1987, Zhao 2008).

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003).

  • improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which aids dispersal of swelling.

  • causing a transient change in sciatic nerve blood flow, including circulation to the cauda equine and nerve root. This response is eliminated or attenuated by administration of atropine, indicating that it occurs mainly via cholinergic nerves?(Inoue 2008).

  • influencing the neurotrophic factor signalling system, which is important in neuropathic pain (Dong 2006).

  • increasing levels of serotonin and noradrenaline, which can help reduce pain and speed nerve repair (Wang 2005).

  • improving the conductive parameters of the sciatic nerve (Zhang 2005).

  • promoting regeneration of the sciatic nerve (La 2005).

Sinusitis

How acupuncture can help

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress (Hui 2010).?

Acupuncture may help to relieve pain and congestion in people with sinusitis by:

  • increasing endorphins?(Ham 2004) and neuropeptide Y levels (Lee 2009), which can help to combat negative affective states

  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz, 1987; Zhao 2008; Cheng 2009);

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007);

  • enhancing natural killer cell activities and modulating the number and ratio of immune cell types (Kawakita 2008);

  • increasing local microcirculation (Komori 2009), which aids dispersal of swelling.

Sports Injuries

How acupuncture can help

One systematic review found strong evidence suggesting that acupuncture is effective in the short-term relief of lateral epicondyle pain (Trinh 2004). This updated an earlier review on the same subject where there was insufficient evidence to either support or refute the use of acupuncture (Green 2002). The only other systematic review on sports injuries found that, based on the results of trials exhibiting a sufficient level of quality, treatments that were effective in decreasing pain and improving function in patients with patellofemoral pain syndrome were acupuncture, quadriceps strengthening, and the use of a resistive brace (Bizzini 2003). There is also positive evidence from individual randomised controlled trials, showing that:

  • acupuncture reduced pain in patients with plantar fasciitis (Zhang 2001);

  • electroacupuncture had better therapeutic effects than medication, both in the short and long term, in patients with acute lumbar strain (Yao-chi 2007);

  • acupuncture plus warmed needle relieved the pain of chondromalacia patella (Qui 2006);

  • acupuncture reduced NSAID intake and relieved pain in patients with shin splints (Callison 2002);

  • acupuncture reduced the pain of patellofemoral pain syndromes (Jensen 1999);

  • acupuncture was effective for soft tissue disease (Yuan 1989).

Case series suggest acupuncture might be helpful in the treatment of shoulder injuries (Osborne 2010), medial collateral ligament injuries of the knee (Yan 2008) and plantar fasciitis (Tillu 1998).

Other Factsheets that relate to sports injuries include: Acupuncture and Back Pain; Acupuncture and Frozen Shoulder; and Acupuncture and Headache.
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety (Wu 1999).

Acupuncture may help relieve symptoms of sports injuries, such as pain and inflammation by:

  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors (e.g. neuropeptide Y, serotonin), and changes the processing of pain in the brain and spinal cord (Pomeranz 1987, Han 2004, Zhao 2008, Zhou 2008, Lee 2009, Cheng 2009);

  • delivering analgesia via alpha-adrenoceptor mechanisms?(Koo 2008);

  • increasing the release of adenosine, which has antinociceptive properties (Goldman 2010);

  • modulating the limbic-paralimbic-neocortical network (Hui 2009);

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003);

  • improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which aids dispersal of swelling.

Stress

How acupuncture can help

Stress is a common complaint cited by acupuncture patients, with a variety of possible associated symptoms. The most prevalent of these is anxiety, for which there is information about acupuncture treatment in the Anxiety Fact Sheet. There are also factsheets on other conditions that are affected by stress, such as back pain, chronic pain, depression, headache, insomnia, irritable bowel syndrome, menopausal symptoms, migraines, premenstrual syndrome and urinary incontinence.

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.

Research has shown that acupuncture treatment may specifically benefit anxiety disorders and symptoms of anxiety by:

  • Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);

  • Improving stress induced memory impairment and an increasing AchE reactivity in the hippocampus (Kim 2011);

  • Reducing serum levels of corticosterone and the number of tyrosine hydroxylase-immunoreactive cells (Park 2010);

  • Regulating levels of neurotransmitters (or their modulators) and hormones such as serotonin, noradrenaline, dopamine, GABA, neuropeptide Y and ACTH; hence altering the brain's mood chemistry to help to combat negative affective states (Lee 2009; Cheng 2009; Zhou 2008);

  • Stimulating production of endogenous opioids that affect the autonomic nervous system (Arranz 2007). Stress activates the sympathetic nervous system, while acupuncture can activate the opposing parasympathetic nervous system, which initiates the relaxation response;

  • Reversing pathological changes in levels of inflammatory cytokines that are associated with stress reactions (Arranz 2007);

  • Reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003);

  • Reversing stress-induced changes in behaviour and biochemistry (Kim 2009).

Stroke

How acupuncture can help

This Factsheet focuses on the evidence for acupuncture in the management of patients post-stroke, both acutely and for rehabilitation. Some other Factsheets may be relevant as they cover conditions commonly associated with stroke: acupuncture and hypertension, acupuncture and depression, acupuncture and chronic pain, and acupuncture and urinary incontinence.

There have been many randomised controlled trials published in the last few years. All have found a positive effect with acupuncture (though not necessarily for all outcome measures) but the methodological shortcomings identified in the reviews largely still apply. Some examples are provided below for a wide range of post-stroke symptoms: functional recovery in general (Hsing 2012, Cheng 2010), motor function (Han 2011, Cheng 2011, Zhang 2011a), cognition (Li 2012a), speech problems (Wang 2011), dysphagia (Xie 2011), shoulder pain (Li 2012b), urinary incontinence (Chu 2011), constipation (Xiao 2011), depression (Wu 2010), fatigue (Zhou 2010), and as a secondary preventive intervention for ischaemic cerebral apoplexy (Cheng 2010).

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.

There have been numerous physiological studies on acupuncture and stroke, largely from China; examples from the last three years are presented in the table below. They indicate multiple possible mechanisms by which acupuncture treatment may help in the management of stroke:

  • Harnessing the anti-inflammatory effects of acetylcholine receptor activation (Wang 2012);

  • Protecting the brain from ischaemic injury by increasing cerebral blood flow (Zhou 2011, Du 2011);

  • Alleviating cerebral oedema after cerebral ischaemia (Zhang 2011b);

  • Preventing the impairment of cortical GABAergic neurons (Zhang 2011c);

  • Regulating differential expression of multiple serum proteins involved in stroke, and enhancing muscle strength recovery (Pan 2011);

  • increasing production of glyco-metabolic enzymes and hence improving post-stroke cognition (Zhao 2011);

  • Improving motor cortical excitability, and facilitating motor function recovery after focal cerebral ischaemic injury (Lin 2010);

  • Restoring the expression of Na(v)1.1 and Na(v)1.6 (sodium channel sub-unit genes that are down-regulated in cerebral ischaemia) thus reducing infarction volume and decreasing stroke damage (Ren 2010);

  • Up-regulating bcl-2 , hence reducing the expression of caspase-3, one of the enzymes involved in programmed cell death in stroke (Chen 2009);

  • Promoting neuroprotective effects against focal cerebral ischaemia (Kang 2010);

  • Modulating brain glutamate release (excessive glutamate in the ischaemic zone is neuro-toxic) (Lee 2010);

  • Increasing the production of endocannabinoid 2-arachidonylglycerol and N-arach-idonoylethanolamine-anandamide, which elicits protective effects against transient cerebral ischaemia through CB1 receptors (Wang 2009);

  • Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);

  • Increasing the release of adenosine, which has antinociceptive properties (Goldman 2010);

  • Reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007).

Substance misuse

How acupuncture can help

Acupuncture is used extensively, and worldwide, in substance misuse treatment centres. This stems from the development of a simple 5-point auricular acupuncture protocol at New York's Lincoln Hospital in the 1970's, originally for drug users but subsequently extended to tobacco, alcohol and other addictive substances and behaviours. The protocol was designed to operate within Western health settings and mutual peer support systems, not as an isolated treatment.

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Wu 1999).

Acupuncture may help relieve symptoms of drug withdrawal by:

  • normalising the release of dopamine in the mesolimbic system. This reduces the over-stimulating effects of abused drugs and modifies behaviours associated with addiction such as those around desire and reward. Several brain neurotransmitter systems, for example serotonin, opioid and GABA, are implicated in this (Lee 2009a, Yang 2008, Zhao 2006)

  • reducing anxiety (Samuels 2008). Acupuncture can alter the brain's mood chemistry, reducing serotonin levels (Zhou 2008) and increasing endorphins (Han 2004) and neuropeptide Y levels (Lee 2009b; Cheng 2009);

  • modulating postsynaptic neuronal activity in the nucleus accumbent and the striatum to reduce nicotine addiction (Chae 2004) and increasing corticotrophin-releasing factor?to attenuate anxiety-like behaviour following nicotine withdrawal (Chae 2008);


Tennis elbow

How acupuncture can help

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety (Wu 1999).

Acupuncture may help relieve symptoms of tennis elbow, such as pain and inflammation by:

  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors (e.g. neuropeptide Y, serotonin), and changes the processing of pain in the brain and spinal cord (Pomeranz 1987, Han 2004, Zhao 2008, Zhou 2008, Lee 2009, Cheng 2009);

  • delivering analgesia via alpha-adrenoceptor mechanisms?(Koo 2008);

  • increasing the release of adenosine, which has antinociceptive properties (Goldman 2010);

  • modulating the limbic-paralimbic-neocortical network (Hui 2009);

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003);

  • improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which aids dispersal of swelling.

Thyroid disease

How acupuncture can help

This factsheet focuses on the evidence for acupuncture in thyroid disease, both hypothyroidism and hyperthyroidism.

One randomised controlled trial (RCT) found that the use of moxibustion separated from the skin by a layer of aconite herbal 'cake', in addition to levothyroxine, can improve clinical symptoms and thyroid function in patients of Hashimoto's thyroiditis compared with levothyroxine alone (Xia 2012). An observational study found that acupuncture may be an alternative to treatment with levothyroxine for subclinical hypothyroidism (Luzina 2011).

Three RCTs have looked at acupuncture for hyperthyroidism. One found that acupuncture combined with acupressure is effective for treating infiltrative exophthalmos (bulging eyes, a common symptom in thyroid eye disease), and more effective than medication (Xu 2011). Another found that the addition of acupuncture to medication for hyperthyroid exophthalmos may not only enhance the therapeutic effects of medication, but also reduce the side effects. (Xia 2010) And, a third found that pricking therapy has a definite therapeutic effect on Graves' disease, via regulation of thyroid function (Li 2006).

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.

Research has shown that acupuncture treatment may specifically help in thyroid disease by:

  • Increasing free thyroxine (FT4) and free tri-iodothyronine (FT3) levels in hypothyroidism (Xia 2012; Hao 2009; Hu 1993);

  • Decreasing serum tri-iodothyronine (TT3), total thyroxine (TT4), free T3 (FT3) and free T4 (FT4) levels and increasing supersensitive thyrotropin (S-TSH) levels in hyperthyroidism (Li 2006);

  • Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);

  • Increasing the release of adenosine, which has antinociceptive properties (Goldman 2010);

  • Improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which aids dispersal of swelling;

  • Reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007);

Tinnitus

How acupuncture can help

Acupuncture may help relieve tinnitus by:

  • acting on the cochlea, specifically on the contractile activity of outer hair cells (Azevedo 2007);
    acting on the function of the efferent olivocochlear system to suppress otoacoustic emissions (Azevedo?2007);

  • altering the brain's chemistry, increasing neuropeptide Y levels (Lee 2009; Cheng 2009), and reducing serotonin levels (Zhou 2008);

  • reducing inflammation, by promoting release of vascular and immunomodulatory actors (Kavoussi 2007, Zijlstra 2003);

  • increasing local microcirculation (Komori 2009), which aids dispersal of swelling.

Type-2 Diabetes

How acupuncture can help

Chinese medical texts have recognized diabetes as 'wasting-thirsting' for thousands of years, relating it to the consumption of too much rich food. Acupuncture therapy is a common approach to treating diabetes in modern China. However, research is scarce and randomized controlled trials almost non-existent. Most clinical studies have focused on peripheral neuropathy, where there is preliminary evidence for an effect (Jiang 2006; Abuaisha 1998). It may help to treat obesity (Cho 2009), which is the primary risk factor for developing type-2 diabetes, and also depression.

Studies on physiological mechanisms, both with humans and laboratory animals, indicate that acupuncture may:

  • regulate insulin production (Lin et al, 2004) and blood sugar levels (Lin 2004; Chang 2006; Cabioglu 2006; Jiang 2006)

  • improve the blood lipid profile (Cabioglu 2005; Jiang 2006) (dyslipidaemia is common in patients with type-2 diabetes and may lead to cardiovascular morbidity and mortality).

  • improve blood circulation (Tsuchiya 2007), thus helping to slow the onset and progression of diabetic circulatory complications

  • moderate the stress response (Sakai?2007)

Most people use acupuncture as part of an integrated diabetes treatment plan because they are already using Western medication. Acupuncture can be safely and effectively combined with Western biomedicine and other treatments such as relaxation exercises and herbal medicine. In addition to offering acupuncture and related therapies, acupuncturists will often make suggestions as to dietary and other lifestyle changes that may be beneficial. Eating a healthy balanced diet, taking regular physical exercise, reducing stress and maintaining a healthy body weight can help to prevent or delay the onset of type-2 diabetes and slow the progression of the disease. Working with a supportive therapist can help people commit to these positive lifestyle changes.


Urinary incontinence

How acupuncture can help

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.

Animal studies have shown that acupuncture treatment may specifically be of benefit in people with urinary incontinence by:

  • decreasing the expression of c-Fos in the brain. Induction of stress urinary incontinence in rats has been shown to increase expression of c-Fos (Chung 2008).

  • controlling nitrergic neurotransmitters in order to increase nitric oxide levels in bladder tissue, thus relaxing smooth muscle and allowing increased bladder capacity (Chen 2006).

There are systematic reviews for acupuncture in two particular instances of urinary incontinences: post-stroke (Thomas 2008) and bed-wetting in children (Bower 2005). Both reported consistently positive results. A general review found acupuncture to be the only CAM therapy with evidence of benefit, albeit at a preliminary level (Hartmann 2009). Individual trials for a variety of types of urinary incontinence (urge, stress, diabetic, post-hysterectomy, post-stroke) have largely positive outcomes across a range of acupuncture interventions and control groups (Engberg 2009; Tang 2009; Kim 2008; Tian 2007; Yi 2008; Liu 2008; Yun 2007). Acupuncture may be most useful when given in addition to appropriate exercise regimes.


Vertigo

How acupuncture can help

A systematic review of research on all types of acupuncture for M?ni?re's syndrome has suggested a beneficial effect from acupuncture, both for patients in the acute phase of the disease and for those who have had the syndrome for a number of years (Long 2011). Randomised controlled trials have been almost entirely Chinese and most have compared different types of acupuncture (or acupuncture and related procedures), rather than acupuncture vs. non-acupuncture/other therapies. Many have focused specifically on cervical vertigo, involving insufficient blood supply through the vertebral arteries (which supply the brainstem and cerebellum). Recent examples found that: combined therapy of electroacupuncture and acupoint injection was more effective than routine acupuncture or electroacupuncture alone for cervical vertigo (Li 2011); acupoint massage was superior to manipulation (Kang 2008); acupuncture was better than moxibustion for relieving or eliminating symptoms of vertigo, with no adverse effects (Zhang 2008); and that ginger moxibustion was superior to acupuncture treatment (Xiaoxiang 2006). A controlled nonrandomised study found both penetrating needling on head points and traditional acupuncture could effectively relieve cervical vertigo, reduce the attack frequency and improve accompanying symptoms (Qi 2011).

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress (Hui 2010).

Acupuncture may help to relieve vertigo by:

  • activating the left superior frontal gyrus, anterior cingulate gyrus, and dorsomedial nucleus of the thalamus, and stimulating the release of acupuncture-specific neural substrates in the cerebellum?(Yoo 2044);

  • increasing blood flow velocity in the vertebral-basilar artery, thus improving cervical vertigo (Li 2011; Qi 2011; Kang 2008)

  • increasing endorphins (Han 2004) and neuropeptide Y levels (Lee 2009), which can help to combat negative affective states;

  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz, 1987; Zhao 2008; Cheng 2009);

  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007);

  • increasing local microcirculation (Komori 2009), which aids dispersal of swelling.