1997 NIH Consensus Myofascial pain Osteoarthritis Low back pain Headache Menstrual cramps Tennis elbow Fibromyalgia Carpal tunnel syndrome Addiction Stroke rehabilitation Asthma The NIH Consensus Development Program. Available at: Accessed September 21, “Acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program”

LI-4 Brain Effects “fMRI can demonstrate the CNS pathway for acupuncture stimulation. Acupuncture at ST.36 and LI.4 … deactivates multiple limbic areas subserving pain association These findings may shed light on the CNS mechanism of acupuncture analgesia…”

III. Acupuncture: Brain Dr Hui Massachusetts General Hospital Needle manipulation at LI-4 – Signal increased in the somatosensory cortex – Signal decreased in limbic system Control: tactile stimulation in the same area elicited only somatosensory activity Hui et al. Hum Brain Mapp. 2000;9:13-25 (B).

Acupuncture: What’s the Point Traditional Properties Improved flow of Qi Clears Stagnation Conventional Properties Changes at the tissue – Temperature – Electrical property Changes at spinal cord – Modify transmission of pain signals – Enhance release of endorphins Changes at the brain – Cortical signaling based on area of acupuncture Reversal with naloxone

Percutaneous Electrical Nerve Stimulation (PENS) for Knee Pain

ACP in Knee Arthritis: RCT At 26 wks, ACP group experienced significant improvement vs. sham ACP in WOMAC & pain score (P=.003) 1 1 Berman et al. Ann Intern Med. 2004;141:

ACP for HA - BMJ study 401 patients with chronic headaches randomized: (12 ACP TXs + usual care) vs. usual care Measurements: – Daily diaries of headache & medications use – Primary outcome = headache score at 1-year follow-up HA scores  34% with ACP 16% in controls (P = ) Larger effects were seen in patients with more severe symptoms BMJ 328[7442]:744, 2004

Conclusions: BMJ study “Acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine.” Compared with controls, patients having ACP: – 22 fewer headaches/ year – Improved quality of life (SF-36) Treatments were cost effective: – 15%  medication (P = 0.02) – 25%  office visits (P = 0.10) – 15%  sick days (P = 0.2) – Cost of treatment similar to sumatriptan

ACP in Headache Acupuncture for patients with migraine: a randomized controlled trial. N= 302 – Reduction in headache days > 50%: 51% in the acupuncture group 53% in the sham acupuncture group, 15% in the waiting list group Acupuncture for chronic headaches--an epidemiological study N= 2022 – In 52.6% of patients, HA frequency  by at least 50% compared to baseline. – “Effect may largely be due to potent “unspecific needling effects” effects” 1.Linde K. JAMA May 4;293(17): Melchant D. et al. Headache Apr;46(4):

ACP in Low Back Pain: Efficacy & Cost Meta-analysis: acupuncture for low back pain. 1 – “Acupuncture effectively relieves chronic low back pain.” Standardized mean difference, 0.54 (95% CI, ) A randomized controlled trial of acupuncture care for persistent low back pain: cost effectiveness analysis. – “The probabilistic sensitivity analysis showed acupuncture to have a more than 90% chance of being cost effective.” 1 1 Manheimer E. et al. Ann Intern Med Apr 19;142(8): Ratcliffe J et al. British Med. J Sep 23;333(7569):626. Epub 2006 Sep 15.