Research
There is a great deal of scientific evidence to support the clinical use of acupuncture for a wide variety of biomedical conditions. The mechanisms of acupuncture are understood at a level on par with other biological and medical sciences.
Supporting Agencies, Cost-Effectiveness, Mechanisms, and
Evidence-Based Clinical Benefits of Acupuncture
written by Kelly A. Ilseman in the role of Research Committee Chair for the Oregon Acupuncturists
Association (OAA) May 2023, adapted for website August 2023
Agencies that Support Acupuncture
Acupuncture is supported as an effective, evidence-based pain-management option by the CDC (1), the Centers for Medicare & Medicaid Services (CMS) (2), the Department of Veterans Affairs (DVA) (3), the American Academy of Pain Medicine (AAPM) (4), the American College of Physicians (5), the FDA (5) The Joint Commission, a hospital accrediting agency (5), the National Academies of Science, Engineering, and Medicine (5), the National Institutes of Health (NIH) (6), and the World Health Organization (WHO) (7).
Cost-Effectiveness
Utilization of acupuncture will reduce the economic burden of treating pain (8,9,10). A 2018 study by the National Academies of Science, Engineering, and Medicine showed a health care costs savings of over $100 per medical event in the treatment of low back pain by conservative integrative care providers (acupuncturists/chiropractors/physical therapists) compared to primary care physicians and a $1,000 savings per medical event compared to specialist care (9). Additionally, the Acupuncture Evidence Project identified 10 conditions for which acupuncture is cost-effective: allergic rhinitis, ambulatory anesthesia, chronic pain, depression, dysmenorrhea, headache, low back pain, migraine, neck pain, osteoarthritis, and post-operative nausea and vomiting (10).
Mechanisms of Acupuncture
Connective Tissue::Evidence for the mechanisms of acupuncture is emerging at the forefront of biological research at a level of physiological detail on par with other biological science disciplines. As visualized by ultrasound, collagen connective tissues wind and pull around acupuncture needles when they are placed into tissue, stimulating matrix deformation, microstructural cellular changes, and mechanotransduction (11-23). These mechanical forces trigger downstream physiological cascades involving biochemical, bioelectrical, and molecular expression pathways that produce tangible physiological effects. Qualities of connective tissue that may contribute to these mechanistic effects include evidence of greater connective tissue density and mast cell concentration at acupuncture points (11), lower electrical impedance and higher conductance along acupuncture channels (24,25), and highly myelinated nerve endings at acupuncture points (26). Researchers have found physiological, histological, and clinical evidence that “the fascia network resembles the theoretical meridian system” (27). Due to its widely systemic effects, the connective tissue mechanism of acupuncture has the potential to serve as a unifying theory, both supporting ancient Chinese ideas of the body as well as modern biomedical ideas (14).
Biochemical/Electrical/Molecular Mechanisms: The downstream biological cascade of events that happens throughout cells, tissues, and organ systems as a result of connective tissue deformation involves anti-inflammatory actions 28,29,30,31,32,33(reducing inflammatory cytokines including Interleukin-1β, Interleukin-6, Interleukin-8, TNF-α, C-reactive protein, nitric oxide synthase (NOS) (30,34), and increasing anti-inflammatory cytokines such as Interleukin-10, IFN-γ, and macrophages) (30,32,33,34); antioxidant effects (28,29,30,34,35); (reducing reactive oxygen species (ROS) and increasing free radical scavengers such as superoxide dismutase (SOD) (29,35), glutathione peroxidase (35), and myeloperoxidase (MPO) (34); autonomic vagus nerve regulation (28,31,34,36); increased endogenous opioids (28,29,32,35,37,38) action on cannabinoid CB2 receptors (30,38); neuromodulation via neurotransmitter actions (28,29,35,36,37,38) (including GABA regulation (34,35) and neuroendocrine actions (28,30,37), including serotonin and substance P regulation (25,30,34), and regulation of the hypothalamic-pituitary-adrenal (HPA) axis (28,30,31,34); neuroimmune regulation via mast cell activation (11,13,30,39,40,41); neuroplastic brain changes visible on fMRI (30,42,43,44,45) neural growth and /regeneration/apoptosis reduction (9,30,38); whole-brain impacts via the default mode network (45); microbiome changes (30,34) which affect mood and pain perception (46); microcirculatory changes (29); and of course, nociceptive/analgesic, pain-relieving actions (14,24,26,27,30,32,36,37,38,45). The changes that occur within the brain and body affect the psychological interpretation and experience of pain (30,45).
Psychological interpretation and experience of pain: Zhang and colleagues (2019) performed neuroimaging studies demonstrating whole brain changes in response to acupuncture, including “a broad network of regions involving not only somatosensory, but affective and cognitive processing” as well (45). Acupuncture has been shown to modulate the brain’s default mode network (DMN) (45). The DMN is involved with periods of quiet rest, meditation, and increased states of internal conscious awareness, and is less active during external, cognitive, task-oriented activities. Deactivation of the DMN represents less connection among the areas of the brain understood to be involved with these external cognitive tasks, and changes that support internal resting states. The authors noted that people experiencing disease and pain, including pain in general, low back pain, multiple sclerosis-related fatigue, depression, and insomnia, autism, schizophrenia, Alzheimer’s disease, ADHD, and PTSD, have “disrupted DMN activities” (45). With low back pain, acupuncture reverses [disrupted brain activity in the DMN] almost to the levels seen in healthy controls, and reductions in clinical pain are correlated with increases in DMN connectivity” (45), with similar results for patients affected by sciatica. These networks, along with changes in the microbiome, and other biochemical and molecular changes contribute to a reduced psychological interpretation and experience of pain (45,46).
Evidence-Based Research: Clinical Benefits
Acupuncture is one of the most safe, effective, and evidence-based non-pharmacological pain management options available for acute and chronic pain, as well as opioid use (9,10,11,47). The benefits of acupuncture have been shown to persist over time (48). Alternatively, opioids offer short-term relief of symptoms such as pain, anxiety, and depression, but few long-term benefits and serious negative impacts such as reduced immunosuppression and potential addiction.48 With acupuncture, patients reported reduced pain, higher quality of life and self-care, and less need for opioids (49).
Download the pdf (includes reference list)
Download the long pdf (w/ references list)
In 2022 the CDC accepted public comment regarding their new Opioid Prescription Guidelines update. Download Kelly's comments, written in her role as Oregon Acupuncturists Association Research Committee Chair.
If you are interested in locating research related to the efficacy of acupuncture for a specific condition, consider the following resources:
Society for Acupuncture Research https://www.acupunctureresearch.org/
PubMed
https://pubmed.ncbi.nlm.nih.gov/
Cochrane Library
https://www.cochranelibrary.com/cdsr/reviews
AcuTrials
http://acutrials.ocom.edu/s/acutrials/page/about
RESEARCH SPOTLIGHT
Remembering Dr. Hugh MacPherson
Written by: Magdalena Ganss
Obtained on February 7, 2021, from the OCOM Library E-Newsletter
Dr. Hugh MacPherson (also known as Professor MacPherson) was, by all accounts, a well-loved man of many talents and had a very rounded personality. It has been said that Professor MacPherson always had time for everything, which was most likely due to his passion for learning and giving. After earning his PhD in mathematics in 1979, Dr. MacPherson went on to study Chinese medicine and became a licensed practitioner in 1983. Following his licensure, Dr. MacPherson dedicated a great deal of time to acupuncture research through the lens of science, an effort which brought the field of acupuncture vastly closer to becoming a widely accepted form of complementary medicine in the western world.
One of Professor MacPherson’s greatest contributions was the development and publication of STRICTA (STandards for Reporting Interventions in Clinical Trials of Acupuncture), which has become the cornerstone of standards for scientific acupuncture studies. This effort was achieved alongside OCOM’s own Dean Emeritus of Research, Dr. Richard Hammerschlag, who kindly shared some memories of Professor MacPherson:
“Hugh was a great friend and colleague, with whom I was fortunate to collaborate with on several projects. Hugh visited OCOM and presented one of the first groups of Research Grand Rounds that were a successful part of OCOM's NIH-funded research education grant. Hugh's talk, on his experience of developing a research program to assess acupuncture effectiveness for low-back pain, was well-received, not only because he was adept at explaining the language of research, but because he was also a practicing acupuncturist, who owned and ran a clinic in his home city of York, UK, and a leader of an acupuncture college in the north of England, which he had co-founded.”
Among Professor MacPherson’s diverse hobbies were cycling, beekeeping, and wind-surfing—a sport he particularly enjoyed practicing in the Hood River when he came to Portland for lectures. Professor MacPherson was passionate about his work and continued working until his retirement in July of 2020, only one month before he passed away from pancreatic cancer. The entire OCOM community and beyond is immensely grateful for all of Dr. MacPherson’s contributions to Chinese medicine.
When I am working on a problem,
I never think about beauty,
but when I have finished,
if the solution is not beautiful,
I know it is wrong.
-Buckminster Fuller