Description of Treatment/Procedure

Acupuncture treatment consists of inserting needles into specific sites at which stimulation of the tissue is reported to exert a maximum therapeutic effect. These sites may be the classically defined acupuncture points or points defined by other criteria. The stimulation may be manual manipulation of the needles or may involve heat or electricity. The exact mechanism for pain relief has not been established.

Committee Summary

Based on a review of evidence available to date, the ICSI Technology Assessment Committee finds the following:

1. The quality of the literature continues to be a concern. As noted in the original report, there are difficulties defining the appropriate experimental model for pain, small sample sizes, difficulties selecting an appropriate control group, and inadequate follow-up. Researchers are being encouraged to compare acupuncture with a standard of care rather than a placebo. The NIH Consensus Panel concluded that further studies of the physiology and clinical value of acupuncture were warranted based on the evidence available. Increased funding by the NIH should foster higher quality research.
   
2. The following conclusions from the original report continue to be valid:
   a. The benefits of acupuncture are not experienced by every patient. To date, there is no way to identify who is most likely to benefit from the procedure. Acupuncture may be helpful for patients who have unsuccessfully exhausted the conventional treatment modalities, who experience adverse consequences with conventional approaches, who prefer to not take pharmacological agents for their condition, or whose comorbidities prevent them from taking certain drug therapies. There is an ongoing need for monitoring of acupuncture trials and for outcome assessment.
   b. If acupuncture is being considered, it must be part of a comprehensive pain treatment program that may include behavioral, pharmacological, and/or physical therapies. The role of acupuncture in a comprehensive treatment program is still being defined. Patients should receive a limited number of treatment sessions with an opportunity to re-evaluate their treatment options after completion of those sessions.
   c. Acupuncture is a safe procedure when performed by properly trained individuals in a clinical environment using sterile, disposable needles.
   
3. For osteoarthritis, acupuncture and sham acupuncture produce similar results. Acupuncture is at least as efficacious as standard oral medications (including diazepam). (Conclusion Grade II)
   
4. For headache pain, acupuncture has been shown to be superior or equal to sham acupuncture in both children and adults and comparable to physiotherapy or beta-blockers in adults. (Conclusion Grade III)
   
5. For low back pain, acupuncture has been found to be more beneficial than no treatment or placebo and comparable to active control treatments (including TENS). The incidence of adverse effects is substantially lower than for many other accepted interventions. In low back pain of nociceptive origin, greater and longer duration improvement was noted following low frequency stimulation. (Conclusion Grade III)