Acupuncture in research worldwide
Acupuncture is originated from China thousands years ago. Can the effect of acupuncture be proved by science? Is it recognised by modern science? What is the status of acupuncture in research? More AO analysed the scientific publications from 2000 to 2014. What is the result?
In the past 15 years 15275 documents were published worldwide including acupuncture-related documents (ARDs) and the title filter for acupuncture-specific documents (ASDs).
Which countries have more publications related to acupuncture? The United States is the most productive country, with 2503 ARD publications; China is the second place with 2143 and South Korea with 925 is in the third. Norway is in the first position for the ARD citation rank, with 25.77 citations per document; Switzerland is in the first position for the ASD citation rank, with 26.66. Brazil has 4.19 citations per document, which corresponds to the 20th position in the ASD citation rankings.
The leading journals are Evidence-Based Complementary Medicine, Acupuncture in Medicine, and The Journal of Alternative and Complementary Medicine. Global numbers of ARDs and ASDs and citations have constantly increased from 2000 to 2014.
More AO et al J Altern Complement Med (2016) May 2[Epub ahead of print]
Acupuncture in the UK
There was a new research across surrey in the UK which studied current situation of acupuncture in health care. The data was collected using questionnaire responded by 330 acupuncture practitioners with professional background including 29% doctors, 29% physiotherapists, 15% nurses and 27% independent acupuncturists. 68% of the practitioners are in independent practice. Patient’s ages are from 9 to 94 year old. The most common visits are for pain conditions including low back, neck, shoulder and knee pain, as well as headaches and migraine. Anxiety, stress and depression were the three most common psychological complaints. Treatment for infertility by independent acupuncturists increased fivefold in 10 years. There are many visits for other conditions including obstetric, gynaecological conditions and digestive, respiratory circulatory and skin complaints etc. In the UK, about 4 million sessions of acupuncture were provided each year, two thirds of which were from independent practice. The style of acupuncture is that 67% is western medical acupuncture and 41% is traditional Chinese medicine. About 90% physiotherapists, nurses and doctors use Western medical acupuncture; while 90% acupuncturists use traditional Chinese medicine.
NHS acupuncture outcome
Most patients pay for private acupuncture treatment, because use of acupuncture in NHS is limited. There is a survey by Robinson TW from Barton House, Beaminster UK published in J Altern Complement Med (2012). This study was to investigate the response to Western acupuncture performed in a National Health Service (NHS) general practice. This is a good survey which included 3 year patient feedback. The outcomes, patient experience, impact on conventional therapies, and appropriateness of acupuncture in general practice were assessed. The patients received acupuncture treatments from all age groups and female to male ratio is 64%:36%. Following the course of acupuncture,
75% of patients noted an improvement in their presenting condition;
26% of patinets were reported complete improvement and 38% major improvement. 24% noted no change.
72% of patients thought that their quality of life was improved.
69% of patients had a reduction or cessation of painkillers and/or anti-inflammatory drugs.
57% of patients thought that referral to hospital specialist or physiotherapist was avoided due to the acupuncture treatment.
23% of patients found acupuncture to be painful; of those 60% said the pain was only mild.
72% of patients were treated within 1 week of being seen by the general practitioner (GP).
81% of patients had one to three treatments.
The patients’ response scores from an anonymised questionnaire showed beneficial outcomes from acupuncture.
Acupuncture is still the most popular CAM treatment option in the UK
In many countries, complementary and alternative medicine (CAM) usage during the last decade is increasing. Perry R et al from University of Exerter, Devon, UK conducted a survey to study the current situation of usage in CAM. They posted a questionnaire to GPs to ask them if they treat, refer, endose or discuss eight common CAM therapies including acupuncture. They also asked about their views on NHS funding, effectiveness, CAM training needs and theoretical validity of each therapy. They compared the results with those from the similar survey collected in 1999. They found that the response rate from GPs was low (30%) compared with that in 1999 (52%). The result showed that the most popular therapies were still acupuncture, hypnotherapy and chiropractic and the least popular therapies were aromatherapy, reflexology and medical herbalism. They suggested that GPs felt most comfortable with acupuncture, with greater belief in its theoretical validity, a greater desire for training and a greater support for acupuncture to receive NHS funding than for the other CAM therapies under question. Opinions about homeopathy ad become less supportive. In my opinion agreed with GPs, acupuncture indeed does amazing job to many people, as I can see many patients have been benefited from acupuncture treatments.
What do GPs think about acupuncture?
More people recognised that acupuncture can help them to get better and use acupuncture for various reasons. What is the opinion of GPs? There was a survey studied the opinions of GP on acupuncture in Italy. Among the responders of GPs, 95% are in favor of acupuncture, 84.2% believe that it is scientifically based, 6% practice acupuncture, 25.2% use it on themselves, and 66.2% have sent at least one patient to an acupuncturist in the last year. 82% of responders are in favour of adding acupuncture training to their own professional practice, and 71.9% believe it would be useful to include acupuncture in specific training for general practice. 64% believe that acupuncture should be included into the benefits offered by the NHS. Data show that interest for acupuncture is higher than that observed in previous international studies carried out on the same topics in the last 20 years. From this study, we can see an increase in confidence and trust in acupuncture.
What is health professional’s opinion about acupuncture in the UK?
British Medical Acupuncture Society is a registered charity and an association of medical practitioners interested in acupuncture. It was established in 1980. There are over 2700 members who use acupuncture in primary or secondary care. They promote the use and scientific understanding of acupuncture as part of the practice of medicine for the public benefit. It also provides education and training of qualified practitioners. What do these health professionals think what sorts of conditions respond to acupuncture treatment? In their opinion there are many conditions responding to acupuncture treatments. For example, Acupuncture is effective in a broad range of painful conditions such as back, shoulder, neck and leg pain; headaches, migraines, trapped nerves, chronic muscle strains and rheumatic and arthritic pain. Some other conditions include functional bowel or bladder problems such as IBS and urinary incontinence; allergies; sinus problems and chronic catarrh; stopping smoking; weight loss and women’s problems etc. This is not complete list and there are many more conditions that can be treated by acupuncture.
Pregnancy acupuncture in the UK.
Recently a survey in the UK was to explore how acupuncturists used acupuncture for maternity care within their women's health practices. 114 survey forms were sent and 99 replies were received, a response rate of 86.8%. The result has shown that in addition to fertility and menstrual conditions, the majority of the practitioners (87 [87.8%]) had treated at least 1 pregnant woman each. The most-common maternity situations encountered were: birth preparation (84 [96.5%]); nausea & vomiting (82 [94.2%]); and inducing labor (79 [90.8%]). More than 50% of the practitioners were also treating lower-back and pelvic pain (77 [88.5%]), breech presentations (74 [85.0%]), threatened miscarriages (55 [63.2%]), and headaches/migraines (46 [52.8%]). Greater number of referrals were received from medical health professionals for pregnancy (54 [65.8%]) than for fertility (16 [19.5%]) or menstrual conditions (8 [9.7%]). They concluded that The most frequently treated menstrual conditions were for irregular periods, menopause, and premenstrual syndrome, while women seeking treatment due to a medical diagnosis, general fertility health, and stress and relaxation were the most-frequent fertility issues. Although the most frequently treated pregnancy conditions concerned nausea, birth preparation, and labor induction, more than half of the practitioners were also treating pregnancy-related lower-back and pelvic pain, breech presentations, threatened miscarriages, and headaches and migraines. Referrals from Western medical practitioners were more common for maternity acupuncture than for fertility or menstrual health.
Hopton AK et al BMJ Open. (2012)11:2-9
Robinson TW J Altern Complement Med (2012) 18:555-60
Perry et al Prim Health Care Res Dev (2013) 10:1-6
Betts D et al Med Acupunct. 2019 Oct 1;31(5):274-280. doi: 10.1089/acu.2019.1386. Epub 2019 Oct 17.
Acupuncture in the US
Sparkling of acupuncture fever in the US
Many people know Mr Henry Kissinger's secret trip from Pakistan to Beijing in 1971 paving the way for President Nixon's visit to China in 1972. To report this, the first U.S. reporter James Reston (1909e1995) was invited by Chinese government to visit China. When he arrived at Beijing at 12th July 1971 and it was too late because Mr Henry Kissinger has already left a day before. He missed a golden chance to cover the breaking news of Kissinger’s visit to China.
A few days later after his arrival, he was told this news. James Reston suddenly felt a stabbing pain in his groin. He went to see doctors in Peking Union Medical College Hospital, Anti-Imperialist Hospital and was diagnosed as acute appendicitis. Next day after an appendectomy surgery, he was in considerable uncomfortable and received acupuncture from Dr Zhangyuan Li. The needles were inserted into his right elbow and below his knees. The needles sent twinges of pain through Reston’s limbs and diverted his attention from the distress in his stomach. Meanwhile he also received moxibustion on his abdomen. There was noticeable relaxation of the pressure and distension within an hour and no recurrence of the problem thereafter. Reston wrote an article entitled Now, About My Operation in Peking in his hospital bed in China and this article appeared on the front page of the New York Times the next day along with the Apollo 15 lift-off on July 26,1971.
What a wonderful story for millions of Americans who were so curious about what was happening in China after its doors have been closed for more than twenty years. Reston's article was the first genuine American acupuncture experience in P. R. China to appear in the mainstream Western media. His story of the ‘Oriental Apollo’ unintentionally sparked widespread ‘acupuncture fever’ across the United States in the coming years. In early 70s, acupuncture stories appeared in many major American media and publications, including Time, People, Life, Newsweek and many more.
Since then acupuncture has become more and more popular. In 1997 a Consensus Development Conference on Acupuncture reported that acupuncture is widely practiced by thousands of physicians, dentists, acupuncturists, and other practitioners. In 2007 NIH Survey estimated that 3.7 US adults and 150 000 children had used acupuncture in 2006 and that between 2002 and 2007, acupuncture use among adults increased by approximately one million people.
The numbers would speak themselves. Acupuncture is one of the most utilized forms of complementary integrative medicine interventions in the United States. During the past 40 years, more than 10 million acupuncture treatments are administered annually in the United States alone. This can be attributed to its effectiveness for pain relief which is proved by scientific studies. Acupuncture for pain management has changed so many people's lives for the better.
Yongming Li Journal of traditional Chinese medical sciences 2014 1:81-83
Jason Jishun Hao, and Michele Mittelman, Glob Adv Health Med. 2014 Jul; 3(4): 6–8.
What does NCCIH say about acupuncture from science aspect?
The National Center for Complementary and Integrative Health (NCCIH) is the Federal Government’s lead agency for scientific research on the diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. NCCIH was formerly known as the National Center for Complementary and Alternative Medicine.
How much do we know about acupuncture?
There have been extensive studies conducted on acupuncture, especially for back and neck pain, osteoarthritis/knee pain, and headache. However, researchers are only beginning to understand whether acupuncture can be helpful for various health conditions.
What the Science Says About the Effectiveness of Acupuncture
Results from a number of studies suggest that acupuncture may help ease types of pain that are often chronic such as low-back pain, neck pain, and osteoarthritis/knee pain. It also may help reduce the frequency of tension headaches and prevent migraine headaches. Therefore, acupuncture appears to be a reasonable option for people with chronic pain to consider. However, clinical practice guidelines are inconsistent in recommendations about acupuncture.
The effects of acupuncture on the brain and body and how best to measure them are only beginning to be understood. Current evidence suggests that many factors—like expectation and belief—that are unrelated to acupuncture needling may play important roles in the beneficial effects of acupuncture on pain. For more information, please see on their website.
For low back pain: Clinical practice guidelines issued by the American Pain Society and the American College of Physicians in 2007 recommend acupuncture as one of several nondrug approaches physicians should consider when patients with chronic low-back pain do not respond to self-care (practices that people can do by themselves, such as remaining active, applying heat, and taking pain-relieving medications).
A 2017 evaluation of the research on acupuncture found evidence that it has a small beneficial effect on acute low-back pain and a moderate beneficial effect on chronic low-back pain. Based on this evaluation, a 2017 clinical practice guideline (guidance for health care providers) from the American College of Physicians (ACP) included acupuncture among the nondrug treatment options for management of both acute and chronic low-back pain.
For neck pain: A large German study with more than 14,000 participants evaluated adding acupuncture to usual care for neck pain. The researchers found that participants reported greater pain relief than those who didn’t receive it; the researchers didn’t test actual acupuncture against simulated acupuncture.
Acupuncture use is increasing in the US
A National Health Interview Survey (NHIS) in the United State was conducted by Upchurch DM & Rainisch BW, UCLA School of Public Health, Los Angeles, CA to study the usage of acupuncture in the US. 22512 adults aged 18 and over were involved in this survey. They showed that from data in 2007 6.8% of adults used acupuncture in their lifetime and 1.5% used in the past 12 months. This showed significantly increased usage of acupuncture compared with previous NHIS survey in 2002 with 4.1% of reported lifetime use of acupuncture and 1.1% use in the past 12 months. Musculoskeletal conditions and pain were the top health conditions treated and integrated conventional and acupuncture were applied to some extent. Negative attitude or scepticism about acupuncture were not common reasons for nonuse among prior and never users. This survey showed a promising result about acupuncture use and recognition in health care in the US population. Indeed acupuncture does have amazing effects on many chronic conditions and does not have severe side effects like many medicines do. Acupuncture could play an important role in health care system.
Acupuncture is most often referred by clinicians in the US
Integrative medicine is a relatively new field which combines conventional medicine and complementary and alternative medicine (CAM) such as herb medicine, acupuncture and meditation. In US many academic health centers have established integrative medicine clinics for patient care. Ehrlich from University of Washington conducted a nationwide survey of clinicians who work at academically affiliated integrative health centers to assess who these clinicians are and to characterize the integrative medicine that they practice. Participants included clinicians who practice at 30 different integrative medicine clinics that are affiliated with academic health centers. They found that clinicians most often reported providing themselves were breathing exercises (66%), herbal medicine prescribing (61%), meditation (44%), and functional medicine (34%). The integrative therapies that clinicians most often referred their patients for were acupuncture (96%), massage (92%), yoga (85%), and meditation (79%). 54% clinicians reported having been involved in research related to integrative medicine in the past year. 20% of their time was spend on teaching.
Depression and anxiety are most commonly treated with acupuncture after lower back pain in the US.
Acupuncture has been a popular alternative medicine in the United States for several decades. It becomes common knowledge that acupuncture can release pain. People with chronic pain often seek acupuncture treatments and it is currently emerging as a unique non-pharmaceutical choice for pain against opioid crisis in the US. For what other conditions do people seek acupuncture treatment in the US? There was a survey studied the conditions that the most commonly treated acupuncture conditions. 419 acupuncturists across the US participated the study. Top 10 conditions that people go for acupuncture are lower back pain, depression, anxiety, headache, arthritis, allergies, general pain, female infertility, insomnia, neck pain and frozen shoulder. Top 99 conditions were grouped into a few categories: pain represents the largest category; and mental health management, especially for mood disorders, is in greatest demand. Immune system dysfunctions, gastrointestinal diseases, gynecology and neurology have also had high ranks.
As you can see that depression and anxiety are most commonly treated with acupuncture after lower back pain. Depression and Anxiety are two different medical conditions, their symptoms, causes, and treatments can often overlap.
Upchurch DM & Rainisch BW J Alterm Complement Med (2014) 2014 Jan;20(1):32-9. doi: 10.1089/acm.2012.0120. Epub 2013 Feb 15.
Burke A et al J Alterm Complement Med (2006) 12:639-48
Wang H et al Am J Chin Med. 2018 Oct 9:1-33. doi: 10.1142/S0192415X18500738.
Acupuncture in Italy
Acupuncture spread across Italy in 1960s and 1970s following other Western countries with a short delay, though the first descriptions of acupuncture reached Italy after Matteo Ricci (1552-1610)’s travels in China.
In 1968, the first medical and scientific acupuncture society was founded named as SIA (Italian Acupuncture Society); it followed a traditional approach adopting the principles of the Chinese medical philosophy. In 1973, the SIRAA (Italian Society of Reflexotherapy, Acupuncture, and Auriculotherapy) was founded which recognised acupuncture to its neurophysiological mechanisms.
In 70s acupuncture was first taught in Italian schools of acupuncture by French teachers. At that time, patients were few, and acupuncture practitioners received insufficient and superficial training.
The real rise in interest of acupuncture occurred in 80s due to the scientific relationships established first with foreign acupuncture schools, above all from the Anglo-Saxon countries and then in later 90 s, with the universities of traditional Chinese medicine in China. Consequently, both teaching activities and clinical practice improved.
In 1987, the founding of the FISA (Italian Federation of Acupuncture Societies) was a milestone for the growth of acupuncture in Italy: The past—represented by the two previous scientific societies, that is, SIA and SIRAA—was superseded by both a political and scientific perspective.
Today, FISA is the leading self-regulatory body for the practice of acupuncture in Italy and represents most Italian MD acupuncturists. It is the only Italian scientific society of acupuncture to be accredited by the Ministry of Health. Its members include 19 medical associations and 13 schools of acupuncture. Since its foundation, 4,187 MDs have been trained and certified by FISA until December 31, 2018. In addition, FISA coordinates national resources, offers assistance, and disseminates information related to acupuncture and TCM to create opportunities for youth to achieve successful futures.
FISA standards are recognized by regional, national, and international associations, institutions, and organizations. FISA has fostered alliances with regional governments and assisted the Ministry of Health in many assignments.
In 1982, the Italian Supreme Court of Cassation asserted that medical doctors could exclusively practice acupuncture. Since then, only people with a degree in medicine and surgery who passed the state exam and were properly certified as a medical doctor could practice acupuncture.
In 2011, FISA President Carlo Maria Giovanardi was appointed Expert of the Superior Health Council for Non-Conventional Medicine. This appointment proved the growing interest of prestigious institutions, such as the Superior Health Council, in acupuncture. Consequently, FISA played a key role in establishing requirements and coordinating teaching activities for education in acupuncture at the State–Regions Conference held on February 7, 2013.
Over the last few years, acupuncture has increasingly spread in Italy. Nowadays, it is administered not only in private clinics, but also in public structures belonging to the National Healthcare Service. When acupuncture was first introduced in Italy, it was mainly used to treat the symptoms of pain syndromes. Therefore, it is most used in public pain relief centers. Over time, its range of application has remarkably increased; it now covers a wide variety of fields, including the treatment of chemotherapy-induced side effects in cancer patients, among others.
Giovanardi CM et al Integr Med Res. 2020 Mar;9(1):1-4. doi: 10.1016/j.imr.2019.12.001. Epub 2019 Dec 17.
Acupuncture is a popular therapy in Norway
Recent years the use of complementary and alternative medicine (CAM) is increasing. A recent Norwegian survey shows that 45 % of the respondents had used CAM within the last 12 months. Massage was the most commonly used CAM method, followed by acupuncture. Acupuncture has been an integrated part of the clinical practice of Norwegian general practitioners (GPs). Many GPs have undergone acupuncture training. A survey involved in 111 GPs has shown that 60 % used acupuncture to treat patients. Fifty-two per cent used acupuncture in more than 5 % of their consultations. Acupuncture was most often used to treat musculoskeletal pain, migraine and tension headache, but was also used in nausea, indigestion, allergies, asthma and sleeping disorders. For the most common disease groups, positive effect was reported in 3 out of 4 patients. From 2001 to 2008 the proportion of Norwegian hospitals offering CAM increased from 25 % to 50.5 % and acupuncture was the therapy most frequently offered.
Jacobsen R et al BMC Complement Altern Med (2015) 15:275
Acupuncture cost is more favourite covered by basic health insurance in Switzerland.
More than 27,000 complementary medicine (CM) therapists are registered in Switzerland. Acupuncturists are one of them. Acupuncture is popular in Switzerland. There is cross-sectional study was based on an online anonymous survey conducted from March to June 2017. All 1549 non-physician registered osteopaths, acupuncturists, and naturopaths in the French-speaking part of Switzerland were asked to complete the survey. The results showed that acupuncturists (71.6%) and naturopaths (64.4%) were significantly more favorable than osteopaths (27.7%) to have consultation costs covered by basic health insurance. A usage of complementary medicine (CM) survey in Switzerland has shown that the average number of treatments within the 12 months preceding the survey ranged from 3 for homeopathy to 6 for acupuncture. 25.0% of the population at the age of 15 and older had used at least one CM method in the previous 12 months. People with a chronic illness or a poor self-perceived health status were more likely to use CM. Similar to other countries, women, people of middle age, and those with higher education were more likely to use CM. 59.9% of the adult population had a supplemental health insurance that partly covered CM treatments. The user profile in Switzerland was similar to other countries, such as Germany, United Kingdom, United States or Australia.
Dubois J et al PLoS One. 2019 Oct 23;14(10):e0224098. doi: 10.1371/journal.pone.0224098. eCollection 2019.
Klein SD et al PLoS One. 2015 Oct 29;10(10):e0141985. doi: 10.1371/journal.pone.0141985. eCollection 2015.
Who is likely to use acupuncture in Germany?
There was a report about characteristics of acupuncture users among internal medicine patients in Germany. 2486 patients were participated the study. The results have shown that 51.49% reported acupuncture use and 39.22% reported no prior use. The use of acupuncture was associated with higher age, i.e. those aged 50-64 were more likely to have used acupuncture, while those younger than 30 were less likely. Patients with spinal pain, fibromyalgia, or headache were more likely to be acupuncture users; while IBS patients were less likely. Patients with good to excellent health status, high external-social health locus of control and current smokers were less likely to have used acupuncture. Among those who had used acupuncture, 42.34% perceived the treatment as helpful, while 35.94% did not. Rated helpfulness was associated with female gender, full-time employment, high health satisfaction, and high internal health locus of control. Those with a diagnosis of osteoarthritis or inflammatory bowel disease were more likely to find acupuncture helpful; those with headache or other types of chronic pain were less likely to find acupuncture helpful. The conclusion was that Acupuncture was used by more than half of internal medicine patients. Prevalence and rated helpfulness of acupuncture use was associated with the patients' medical condition, sociodemography, and health locus of control.
Cramer H et al Complement Ther Med (2015) 23:423-9
Why patients use acupuncture in New Zealand?
Acupuncture is used to treat many conditions in china for thousands years. Acupuncture is now used by many people in Western world for some reasons. Why people use acupuncture? Studies in New Zealand have shown that patients' reasons for using acupuncture are diverse and include dissatisfaction with conventional medicine and attraction to holistic and empowering models of healthcare. Patients mostly accessed acupuncture for musculoskeletal and pain-related conditions. Treatment is thought to relieve symptoms of the presenting concern and a range of other effects that improve well-being. Acupuncture was viewed to be appropriate for treating chronic and quality of life health issues. The barrier to access acupuncture was treatment-associated cost.
Jakes and Kirk (2015) J Prim Helath Care 7:124-9
Jakes et al (2014) J Altern Complement Med 20:663-71
Acupuncture is also popular in Russia
Acupuncture is very popular in the US and Europe. How about acupuncture in Russia?
Here is an interesting article about acupuncture development in Russia.
Peculiarities of the development of acupuncture in Russia by A. Kachan
St Petersburg Medical Academy of Postgraduate Study, 14, Vavilovykh Street (Hospital N3), 195257 St Petersburg, Russia
In 1928 P.Charukosky, a physician from Saint Petersburg, applied acupuncture for the first time in Russia. Since 1956 a new stage in the successful development of acupuncture started thanks to professors V.G.Vogralik and I.I.Rusetzky. In 1957 about 20 senior lecturers, professors, scientists and 6 students of medicine were sent to China for 6 months to study Chinese traditional medicine for many years. In 1959 the Ministry of Public Health included acupuncture (reflexotherapy) in the state-run medicine; intensive research has been carried out in scientific centres of Moscow, Saint Petersburg, Kazan, Nizhny Novgorod and other cities and extensive practical application has spread in the country. In 1974 systematic post-graduation teaching was started. In 1997 the Ministry of Public Health of the Russian Federation approved a separate medical special field called "reflexotherapy" (acupuncture), and in 1999 it issued regulations for the operation of the reflexotherapy service in Russia (the status of a reflexotherapist, a doctor's room, the working load, equipment and tools). Throughout Russia, Acupuncture and Chinese medicine seminars and conferences are regularly held. Physicians are taught acupuncture. There are a few journals and books on this topic.