Acupuncture is now more accepted around the world, but how does it really work?

The ancient Chinese practice is based on the concept of qi, an energy that flows within the human body, and the insertion of the needles at specific points of the body is said to realign its flow, which is believed to have been disrupted and causing the illness or ailment.

Interestingly, the traditional Chinese medicine was said to have been debunked as superstition early in the 1600s, and by the 1800s, was completely abandoned in favour of evidence and science-based medicines.

It was only in the 1950s that Chinese Communist Party leader Mao Zedong, who, in lieu of the growing population in need of medical care, revived the practice of acupuncture – as a more cost-effective approach than Western medicine.

Scientists dissatisfied with the lack of scientific evidence in acupuncture

Mao’s successful revival of acupuncture has led to the spread of its practice across continents, and is now a widely accepted – and rejected – treatment approach for various ailments.

While proponents of the practice strongly believe that the effects of acupuncture are real, others, mostly members of the scientific medical community, argue that it is a sham practice that is not based on legitimate scientific evidence and dub acupuncture as a pre-scientific superstition.

Refuting the claims of acupuncture, professor of biomedical engineering, computer science and biostatistics at Johns Hopkins University, Steven Salzberg, wrote that similar to the emergence of fake news, fake medical journals also exist and are based on fanciful topics that were “complete and utter nonsense,” citing The Journal of Acupuncture and Meridian Studies as well as Acupuncture in Medicine, which are publications of Elsevier and the British Medical Journal respectively, as farce and platforms for pseudoscience.

“I’ve read enough acupuncture studies for one lifetime, and acupuncture doesn’t work for anything,” he said. “It’s nothing more than an elaborate, theatrical placebo.”

Other scientists have also pointed out that acupuncture has no basis in medicine or physiology, and clinical trials have failed to produce a plausible mechanism or strong scientific evidence to prove its effectiveness, while also highlighting the adverse risks of acupuncture, including risk of infection and lesions at puncture sites.

As such, recent guidelines by the National Institute for Health and Care Excellence (NICE) for treatment of low back pain states that “there was still not compelling and consistent evidence of a treatment-specific effect for acupuncture.”

“Acupuncture does not work, which means all discussions of how it does work are irrelevant,” said David Colquhoun, a pharmacologist and neurologist at University College London.

Acupuncture: True relief or a placebo effect?

Despite the lack of scientific evidence, acupuncture is still in high demand – and believed in by many.

“One major hypothesis is that acupuncture works through neurohormonal pathways,” said Ting Bao, an integrative oncologist at Memorial Sloan-Lettering Cancer, who further posited that the needles trigger nerves to release hormones that may alleviate pain.

“It isn't implausible that the effect of a lot of needles may change central pain processing in some concrete way,” added Josephine Briggs, director of the National Center for Complementary and Integrative Health in the UK.

In fact, a study in mice conducted in 2010 found that acupuncture needles triggered the release of adenosine from the surrounding cells, which suggested that acupuncture may manipulate the body into producing natural painkillers.

While the study itself does not prove effectiveness of acupuncture, Dr Andrew Vickers, an attending research methodologist at Memorial Sloan-Kettering Cancer Center and his team concluded that “there’s firm evidence supporting acupuncture for the treatment of chronic pain.”

They performed a thorough meta-analysis comparing acupuncture with over-the-counter pain medication as well as sham acupuncture treatments, revealing that approximately 50% of patients treated with true acupuncture reported improvements.

“We saw a measurable effect there,” said Vickers. “They’re not just getting some placebo effect.”

Yet, even if acupuncture purely resulted in a placebo effect, it is a powerful phenomenon.

“If a placebo can target and modulate these endogenous systems, that’s a good and a real thing,” says Vitaly Napadow, director of the Center for Integrative Pain Neuroimaging at Harvard Medical School.

“(Acupuncture) won’t cure cancer,” he added. “But it could be effective for managing side effects of radiation or chemotherapy—things like pain or neuropathy or nausea.”

Despite these reasoning, scientists remain skeptical of the theories that have yet to be proven, and Briggs believes that there is still good reason to study and improve the understanding of acupuncture as well as the possibility of manipulating the body and mind for better treatments for pain.

But until clinical trials can produce strong evidence to support the use of acupuncture as a treatment approach, the long-standing debate will continue amongst health professionals and the public alike. MIMS

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