Introduction
Acupuncture is one of the oldest, most commonly used medical procedures in the world. Originating in China more than 2,000 years ago, acupuncture began to become better known in the United States in 1971, when New York Times reporter James Reston wrote about how doctors in China used needles to ease his abdominal pain after surgery. Research shows that acupuncture is beneficial in treating a variety of health conditions.

In the past two decades, acupuncture has grown in popularity in the United States. A Harvard University study published in 1998 estimated that Americans made more than five million visits per year to acupuncture practitioners.1 The report from a Consensus Development Conference on Acupuncture held at the National Institutes of Health (NIH) in 1997 stated that acupuncture is being "widely" practiced--by thousands of physicians, dentists, acupuncturists, and other practitioners--for relief or prevention of pain and for various other health conditions.2

NIH has funded a variety of research projects on acupuncture. These grants have been awarded by the National Center for Complementary and Alternative Medicine (NCCAM), the Office of Alternative Medicine (OAM, NCCAM's predecessor), and other NIH Institutes and Centers.

This fact sheet provides general information about acupuncture, research summaries, a glossary that defines terms underlined in the text, and a resource section.

Acupuncture Theories
Traditional Chinese medicine theorizes that there are more than 2,000 acupuncture points on the human body, and that these connect with 12 main and 8 secondary pathways called meridians. Chinese medicine practitioners believe these meridians conduct energy, or qi (pronounced "chee"), throughout the body.

Qi is believed to regulate spiritual, emotional, mental, and physical balance and to be influenced by the opposing forces of yin and yang. According to traditional Chinese medicine, when yin and yang are balanced, they work together with the natural flow of qi to help the body achieve and maintain health. Acupuncture is believed to balance yin and yang, keep the normal flow of energy unblocked, and maintain or restore health to the body and mind.

Traditional Chinese medicine practices (including acupuncture, herbs, diet, massage, and meditative physical exercise) all are intended to improve the flow of qi.3

Western scientists have found meridians hard to identify because meridians do not directly correspond to nerve or blood circulation pathways. Some researchers believe that meridians are located throughout the body's connective tissue;4 others do not believe that qi exists at all.5,6 Such differences of opinion have made acupuncture an area of scientific controversy.

Mechanisms of Action
Several processes have been proposed to explain acupuncture's effects, primarily those on pain. Acupuncture points are believed to stimulate the central nervous system (the brain and spinal cord) to release chemicals into the muscles, spinal cord, and brain. These chemicals either change the experience of pain or release other chemicals, such as hormones, that influence the body's self-regulating systems. The biochemical changes may stimulate the body's natural healing abilities and promote physical and emotional well-being.7 There are three main mechanisms:

Conduction of electromagnetic signals: Western scientists have found evidence that acupuncture points are strategic conductors of electromagnetic signals. Stimulating points along these pathways through acupuncture enables electromagnetic signals to be relayed at a greater rate than under normal conditions. These signals may start the flow of pain-killing biochemicals, such as endorphins, and of immune system cells to specific sites in the body that are injured or vulnerable to disease.8,9

Activation of opioid systems: Research has found that several types of opioids may be released into the central nervous system during acupuncture treatment, thereby reducing pain.10

Changes in brain chemistry, sensation, and involuntary body functions: Studies have shown that acupuncture may alter brain chemistry by changing the release of neurotransmitters and neurohormones. Acupuncture also has been documented to affect the parts of the central nervous system related to sensation and involuntary body functions, such as immune reactions and processes whereby a person's blood pressure, blood flow, and body temperature are regulated.3,11,12
Preclinical studies have documented acupuncture's effects, but they have not been able to fully explain how acupuncture works within the framework of the Western system of medicine.13,14,15, 16,17,18

According to the NIH Consensus Statement on Acupuncture:

Acupuncture as a therapeutic intervention is widely practiced in the United States. While there have been many studies of its potential usefulness, many of these studies provide equivocal results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebos and sham acupuncture groups. However, promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful.7
Increasingly, acupuncture is complementing conventional therapies. For example, doctors may combine acupuncture and drugs to control surgery-related pain in their patients.19 By providing both acupuncture and certain conventional anesthetic drugs, some doctors have found it possible to achieve a state of complete pain relief for some patients.10 They also have found that using acupuncture lowers the need for conventional pain-killing drugs and thus reduces the risk of side effects for patients who take the drugs.20,21

Currently, one of the main reasons Americans seek acupuncture treatment is to relieve chronic pain, especially from conditions such as arthritis or lower back disorders.22,23 Some clinical studies show that acupuncture is effective in relieving both chronic (long-lasting) and acute or sudden pain, but other research indicates that it provides no relief from chronic pain.24 Additional research is needed to provide definitive answers.

FDA's Role
The U.S. Food and Drug Administration (FDA) approved acupuncture needles for use by licensed practitioners in 1996. The FDA requires manufacturers of acupuncture needles to label them for single use only.25 Relatively few complications from the use of acupuncture have been reported to the FDA when one considers the millions of people treated each year and the number of acupuncture needles used. Still, complications have resulted from inadequate sterilization of needles and from improper delivery of treatments. When not delivered properly, acupuncture can cause serious adverse effects, including infections and punctured organs.26

Clinical Research Sponsored by NCCAM and OAM
Created by a mandate from the U.S. Congress in 1998, NCCAM is dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training complementary and alternative medicine (CAM) researchers, and disseminating authoritative information to the public and professionals. Research on acupuncture has been supported by NCCAM and OAM, and continues to be supported by NCCAM. Examples of projects and findings are discussed below. (For the most updated information on current and past research projects funded by NCCAM, consult the Computer Retrieval of Information on Scientific Projects (CRISP) database.)

As of March 2002, NCCAM supports 16 Specialty Centers of Research, where scientists conduct studies on CAM for specific health conditions and diseases. Scientists at two centers are investigating acupuncture therapy:

The Center for Alternative Medicine Research on Arthritis, at the University of Maryland in Baltimore, is conducting research exploring the efficacy, safety, and cost-effectiveness of acupuncture treatment for osteoarthritis of the knee, and the mechanism of action and effects of electroacupuncture on persistent pain and inflammation.

The Center for Addiction and Alternative Medicine Research at the Minneapolis Medical Research Foundation, Minnesota, is carrying out preclinical trials of electroacupuncture to map the parts of the brain involved in dependence on opioids.
Other research on acupuncture that NCCAM funds includes the following:

A team led by scientists at New England Research Institutes and Massachusetts General Hospital is conducting a pilot study that may move forward into a large-scale clinical trial, on the effects of acupuncture on hypertension.27

A pilot study at the University of California at Los Angeles on the effect of acupuncture on heart failure patients has shown some interesting preliminary results. Patients treated by acupuncture had significant reduction in sympathetic nerve activation, which is usually increased in this group of patients and has an adverse effect on the disease course.28
With the support of OAM, researchers at the University of Maryland in Baltimore conducted a randomized controlled clinical trial and found that patients treated with acupuncture after dental surgery had less intense pain than patients who received a placebo.19 Scientists at the university also found that older people with osteoarthritis experienced significantly more pain relief after using conventional drugs and acupuncture together than those using conventional therapy alone.29

OAM also funded several preliminary studies on acupuncture:

In one small randomized controlled clinical trial, more than half of 11 women with a major depressive episode who were treated with acupuncture improved significantly.30

In another controlled clinical trial, nearly half of the seven children with attention deficit hyperactivity disorder who underwent acupuncture treatment showed some improvement in their symptoms. Researchers concluded that acupuncture was a useful alternative to standard medication for some children with this condition.31

In a third small controlled study, eight pregnant women were given a type of acupuncture treatment called moxibustion to reduce the rate of breech births, in which the fetus is positioned for birth feet-first instead of the normal position of head-first. Researchers found the treatment to be safe, but they were uncertain whether it was effective.32 Then, researchers reporting in the November 11, 1998, issue of the Journal of the American Medical Association conducted a larger randomized controlled clinical trial using moxibustion for breech births. They found that moxibustion applied to 130 pregnant women presenting breech significantly increased the number of normal head-first births.33

Acupuncture and You
The use of acupuncture, like the use of many other CAM treatments, has produced a good deal of anecdotal evidence. Much of this evidence comes from people who report their own successful use of the treatment. If a treatment appears to be safe and patients report recovery from their illness or condition after using it, others may decide to use the treatment. However, scientific research may not support the anecdotal reports.

Lifestyle, age, physiology, and other factors combine to make every person different. A treatment that works for one person may not work for another who has the very same condition. You as a health care consumer (especially if you have a preexisting medical condition) should discuss any CAM treatment, including acupuncture, with your health care practitioner. Do not rely on a diagnosis of disease by an acupuncture practitioner who does not have substantial conventional medical training. If you have received a diagnosis from a doctor and have had little or no success using conventional medicine, you may wish to ask your doctor whether acupuncture might help.

Finding a Licensed Acupuncture Practitioner
Health care practitioners can be a resource for referral to practitioners of acupuncture, as more are becoming aware of this CAM therapy. More medical doctors, including neurologists, anesthesiologists, and specialists in physical medicine, are becoming trained in acupuncture, traditional Chinese medicine, and other CAM therapies. In addition, national organizations (consult your local library or search with a Web browser) may provide referrals to practitioners, although some organizations may encourage the use of their practices.

Check a practitioner's credentials.
A practitioner who is licensed and credentialed may provide better care than one who is not. About 40 States have established training standards for acupuncture certification, but States have varied requirements for obtaining a license to practice acupuncture.34 Although proper credentials do not ensure competency, they do indicate that the practitioner has met certain standards to treat patients through the use of acupuncture.

Check treatment cost and insurance coverage.
A practitioner should inform you about the estimated number of treatments needed and how much each will cost. If this information is not provided, ask for it. Treatment may take place over a few days or for several weeks or more. Physician acupuncturists may charge more than nonphysician practitioners. Check with your insurer before you start treatment as to whether acupuncture will be covered for your condition, and if so, to what extent. Some plans require preauthorization for acupuncture.

Check treatment procedures.
Ask about the treatment procedures that will be used and their likelihood of success for your condition or disease. You also should make certain that the practitioner uses a new set of disposable needles in a sealed package every time. The FDA requires the use of sterile, nontoxic needles that bear a labeling statement restricting their use to qualified practitioners. The practitioner also should swab the puncture site with alcohol or another disinfectant before inserting the needle.
During your first office visit, the practitioner may ask you at length about your health condition, lifestyle, and behavior. The practitioner will want to obtain a complete picture of your treatment needs and behaviors that may contribute to the condition. Inform the acupuncturist about all treatments or medications you are taking and all medical conditions you have.

The Sensation of Acupuncture
Acupuncture needles are metallic, solid, and hair-thin. People experience acupuncture differently, but most feel no or minimal pain as the needles are inserted. Some people are energized by treatment, while others feel relaxed.35 Improper needle placement, movement of the patient, or a defect in the needle can cause soreness and pain during treatment.36 This is why it is important to seek treatment from a qualified acupuncture practitioner.