Conditions it can help

Levels of Evidence
Medical scientists and others consider that the evidence for effectiveness of any medical treatment ranges from weak to strong. An individual whose pain has been permanently eliminated by acupuncture might be shocked and offended to find that for his or her particular pain problem, acupuncture is considered to not work, based on lack of evidence from well-designed clinical studies or no studies having been done.

The Randomized Controlled Trial (RCT) is the ‘gold standard’ of medical research that was developed to test medications for effectiveness. An RCT has at least two groups of individuals who are treated and assignment to the groups is randomized. One is a control group that usually gets a pretend treatment referred to as a placebo and, in the case of drugs, no one conducting the study or the individuals being treated knows which treatment anyone is receiving. Of course, there can be no such thing as a double blind study of acupuncture, because the person doing the acupuncture knows that the treatment is real or fake. For acupuncture it is more difficult to do controlled studies, but attempts are being made by good researchers around the world.

There is a hierarchy of strength of clinical evidence that looks like a pyramid, with the strongest evidence being at the top:

Figure 1: Hierarchy of Evidence. After Ernst, 1999

Most of the vast amount of evidence for the benefits of acupuncture remains in the ‘Uncontrolled Data’ section, of course. The long history of its role in Chinese, Japanese and Korean medicine before it became well known in the west is a testament to its effectiveness. Starting in the early 1970s, the anecdotal evidence for the benefits of acupuncture have also been finding firm ground to stand on in virtually all countries outside of Asia.

There are at the present time, only a few conditions for which there is the highest level of evidence, systemic reviews of randomized controlled trials (RCTs), for acupuncture treatment. This is because it takes a very long time to do high quality clinical trials in acupuncture that have a good placebo control group and funding is not as readily available for acupuncture studies as it is for pharmaceutical studies. In spite of these difficulties, teams of researchers are doing clinical research and results appear regularly on the internet and in well-respected peer-reviewed journals.

Gradually, the clinical research evidence for the effectiveness of acupuncture is increasing as more RCTs are being reported all the time. The difficulty with some of these studies is that attempts to perform a ‘placebo’ form of acupuncture using sham needles ^20,21 and other methods sometimes results in there not being a statistically significant difference in the outcomes between the sham and the real acupuncture groups, although both are better than a group that gets no acupuncture or some other treatment.

The implications of these results include the possibility that the sham had an effect and there is intriguing evidence that this could be possible.^22,23,24,25

The National Health and Medical Research Council of Australia uses the following scale to describe the levels of evidence:

I Evidence obtained from a systematic review of all relevant randomised controlled trials.
II Evidence obtained from at least one properly designed randomised controlled trial
III-1 Evidence obtained from well-designed pseudo-randomised controlled trials (alternate allocation or some other method)
III-2 Evidence obtained from comparative studies with concurrent controls and allocation not randomised (cohort studies), case-controlled studies or interrupted time series with a control group
III-3 Evidence obtained from comparative studies with historical control, 2 or more single-arm studies, or interrupted time series without a parallel control group
IV Evidence obtained from case series, either post-test or pre-test and post-test

If you ‘Google’ evidenced based medicine you will see that there is no agreement on which scale is best and lots of argument and criticism of studies. The above scale is much simpler than the one you will find at the Centre for Evidence-Based Medicine at Oxford University. www.infopoems.com/concept/ebm_loe.cfm


The conditions for which one can say that there is the highest level of evidence that acupuncture is effective include:

• Low back pain ^26,27
• Acute vomiting induced by chemotherapy ²⁸
• Post-operative nausea and vomiting ²⁹
• Neck disorders ³⁰
• Recurrent headache ³¹ and Idiopathic headache ³²

One must always keep in mind that lack of good evidence for effectiveness does not necessarily mean that there is good evidence of ineffectiveness.

Indications for Acupuncture Based on Clinical Experience:
• Painful Conditions Treatable by Acupuncture
• Internal Medicine Disorders  
• Neurological Dysfunctions
• Psychological/Addictions/Lifestyle Disorders
• Gynecological Conditions
• Urological Conditions

PAINFUL CONDITIONS TREATABLE BY ACUPUNCTURE
Cancer pain 

• Due to malignancy
                            - Bone pain
                            - Abdominal pain
                            - Local invasion by tumour
• Secondary to bed rest/inactivity
                            - Myofascial pain
                            - Pressure sores
• Secondary to Cancer Treatment
                            - Post Herpetic Neuralgia
                            - Shoulder/Hand Syndrome
                            - Myofascial Pain
                            - Post-Surgical Pain
                            - Post-Radiation Pain

Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy
Fibromyalgia
Headaches

• Migraine headaches
• Cluster headaches
• Myofascial headaches

Musculoskeletal conditions

• Ankylosing Spondylitis 
• Back pain: myofascial, discogenic, facet OA 
• Osteoarthritis: knee, hip, etc 
• Tendinitis 
• Tennis elbow 
• Whiplash 
• Etc.

Neuralgias

• Post-herpetic neuralgia 
• Trigeminal neuralgia

Neuropathic pain

• Central 
• Peripheral

Spinal Cord Injury pain
Etc.


INTERNAL MEDICINE DISORDERS TREATABLE BY ACUPUNCTURE
Autonomic Nervous System dysfunctions: e.g. Raynaud’s
• Digestive disorders

• Constipation 
• Crohn’s Disease 
• Diarrhea 
• Duodenal Ulcer 
• Gastric Stasis 
• Irritable Bowel Syndrome 
• Etc.

Chronic Fatigue Syndrome
Respiratory disorders

• Asthma 
• Allergies 
• Allergic Rhinitis 
• Sinusitis 
• Etc.

NEUROLOGICAL DYSFUNCTIONS ACUPUNCTURE CAN HELP
• Stroke
• Bell’s palsy
• Spasticity
• Multiple Sclerosis
• Restless Legs Syndrome


PSYCHOLOGICAL/ADDICTIONS/LIFESTYLE PROBLEMS HELPED BY ACUPUNCTURE
• Anxiety
• Depression
• Addictions: Nicotine/Alcohol/Heroin/Cocaine
• Stress management

GYNECOLOGICAL CONDITIONS TREATABLE BY ACUPUNCTURE
• Dysmenorrhea
• Endometriosis
• Infertility
• Menopausal symptoms
• Pelvic pain
• Premenstrual Syndrome

UROLOGICAL CONDITIONS TREATABLE BY ACUPUNCTURE

• Urinary Incontinence
• Chronic Pelvic Pain
• Prostatitis



A full systematic review on the efficacy of acupuncture is beyond the scope of this review. For more up to date research, see the following links:
 National Institutes of Health: http://www.nlm.nih.gov/medlineplus/acupuncture.html
 The Cochrane Library: www.theCochraneLibrary.com
 The World Health Organization: http://www.who.int/topics/acupuncture/en/
 PubMed: www.pubmed.gov