The Acupuncture Evidence Project – a deeper look

The Acupuncture Evidence Project supports the use of acupuncture for headaches, migraines, back pain, knee pain, nausea and vomiting (post-operative and during chemotherapy), allergic rhinitis and post-operative pain.  The Acupuncture Evidence Project also spent some time analysing the mechanisms behind acupuncture’s pain reducing effect.  It is pretty dense, so I will copy it in full below, but essentially there are multiple biochemical pathways in which acupuncture is active and produces both analgesic and anti-inflammatory effects.

The Acupuncture Evidence Project

Acupuncture for back pain“Mechanisms underlying acupuncture analgesia have been extensively researched for over 60 years.  In animal models, acupuncture and/or electroacupuncture have been shown to be effective for the alleviation of inflammatory, neuropathic, cancer, and visceral pain (60).  Ascending neural pathways involving Aδ, Aβ and C sensory fibres have been mapped, the mesolimbic loop of analgesia in the brain and brain stem has been identified and descending pathways have also been mapped (61).

Numerous mediators have been identified including opioid and non-opioid neuropeptides, serotonin, norepinephrine, dopamine, cytokines, glutamate, nitric oxide and gamma-amino-butyric-acid (GABA) (60, 61).  Acupuncture analgesia has been shown to involve several classes of opioid neuropeptides including enkephalins, endorphins, dynorphins, endomorphins and nociceptin (also known as Orphanin FQ) (61-63).

Among the non-opioid neuropeptides, substance P (SP), vasoactive intestinal peptide (VIP) and calcitonin gene-related peptide (CGRP) have been investigated for their roles in both the analgesic and anti-inflammatory effects of acupuncture (60, 64).  Two recent reviews of acupuncture analgesia research further demonstrate the complexity of this area of study (61, 62).

The anti-inflammatory effects of acupuncture involve numerous mediators, receptors and signalling pathways, as outlined in two recent reviews (64, 65).  The anti-inflammatory effects of acupuncture have particular relevance to allergic rhinitis, irritable bowel syndrome, post-surgical recovery, migraine, osteoarthritis and inflammatory aspects of a range of musculoskeletal conditions.  In allergic rhinitis, acupuncture has been shown to down-regulate total and specific IgE, as well as SP and VIP (32, 66).

Acupuncture has been shown to down-regulate transient receptor potential vanilloid 1 (TRPV1) in inflammatory pain and there is indirect evidence to suggest that acupuncture may down-regulate TRPV1 expression and sensitivity in allergic rhinitis (32, 64, 67).  In irritable bowel syndrome, acupuncture has been shown to down-regulate SP, VIP and CGRP (68, 69).  In migraine, acupuncture has been reported to down-regulate CGRP and SP which are also powerful vasodilators (70, 71).

They also pointed to the fact there is a body of research for other mechanisms involved in acupuncture, including;

  • Regulating female reproductive function
  • Regulating gastrointestinal function
  • Regulating bladder function
  • Regulating circulation

In the next level of evidence, where, ‘reviews report[ed] all individual randomized controlled trials or pooled effects across randomized controlled trails as positive, but the reviewers deem[ed] the evidence insufficient to draw firm conclusions.  The quality of evidence is rated as moderate or high quality.’  The evidence project identified:

  • Acute low back pain

    How does acupuncture work

    Credit: Welcome Library, London

  • Acute stroke
  • Ambulatory anaesthesia
  • Anxiety
  • Aromatase-inhibitor-induced arthralgia
  • Asthma in adults
  • Back or pelvic pain during pregnancy
  • Cancer pain
  • Cancer-related fatigue
  • Constipation
  • Craniotomy anaesthesia
  • Depression (with antidepressants)
  • Dry eye
  • Hypertension (with medication)
  • Insomnia
  • Irritable bowel syndrome
  • Labour pain
  • Lateral elbow pain
  • Menopausal hot flushes
  • Modulating sensory perception thresholds
  • Neck pain
  • Obesity
  • Perimenopausal & postmenopausal insomnia
  • Plantar heel pain
  • Post-stroke insomnia
  • Post-stroke shoulder pain
  • Post-stroke spasticity
  • Post-traumatic stress disorder
  • Prostatitis pain/chronic pelvic pain syndrome
  • Recovery after colorectal cancer resection
  • Restless leg syndrome
  • Schizophrenia (with antipsychotics)
  • Sciatica
  • Shoulder impingement syndrome (early stage) (with exercise)
  • Shoulder pain
  • Smoking cessation (up to 3 months)
  • Stroke rehabilitation
  • Temporomandibular pain”

A diversity of conditions

What is most interesting about this list  from the Acupuncture Evidence Project is that there is such a diversity of conditions.  The list covers pain relief and anti-inflammatory conditions, and also mental ill-health conditions, hormonal conditions and complicated, chronic conditions.

With such high quality research from the Acupuncture Evidence Project concerning acupuncture and its effects, and the experience of practitioners over the centuries now being ratified, it is an exciting time indeed to be an acupuncturist.

Thoughts on the Acupuncture Evidence Project

Whilst still on this topic, I would like to add a couple of afterthoughts.  It is, of course, great that such research is coming out and that it will hopefully allow policy makers to begin recommending acupuncture for more conditions.  However, as an individualised, patient-focused, and holistic approach that employs a wide variety of tools, acupuncture is hard to condense into the systematic, one-size fits all approach of allopathic medicine.  Indeed, in my experience, many of the conditions listed in the lower levels of evidence benefit most from a combined approach of acupuncture, herbal medicine and dietary and lifestyle changes.