Acupuncture: Sharp answers to pointed questions

Acupuncture involves the insertion of extremely thin needles to various depths at strategic points on your body. Acupuncture originated in China thousands of years ago, but over the past two decades its popularity has grown significantly within the United States. Although scientists don't fully understand how or why acupuncture works, some studies indicate that it may provide a number of medical benefits — from reducing pain to helping with chemotherapy-induced nausea.

What happens during an acupuncture treatment session?

Acupuncture therapy usually involves a series of weekly or biweekly treatments in an outpatient setting. It's common to have up to 12 treatments in total. Although each acupuncture practitioner has his or her own unique style, each visit typically includes an exam and an assessment of your current condition, the insertion of needles, and a discussion about self-care tips. An acupuncture visit generally lasts 30 to 60 minutes.

During acupuncture treatment, the practitioner uses sterilized, individually wrapped stainless steel needles that are used only once and then thrown away. You may feel a brief, sharp sensation when the needle is inserted, but generally the procedure isn't painful. It's common to feel a deep aching sensation when the needle reaches the correct spot. After placement, the needles are sometimes moved gently or stimulated with electricity or heat.

How does acupuncture work?

The traditional Chinese theory behind acupuncture as medical treatment is very different from that of Western medicine. In traditional Chinese medicine, imbalances in the basic energetic flow of life — known as qi or chi (chee) — are thought to cause illness. Qi is believed to flow through pathways (meridians) in your body. These meridians and the energy flow are accessible through approximately 400 different acupuncture points. By inserting extremely fine needles into these points in various combinations, acupuncture practitioners believe that your energy flow will rebalance. This will allow your body's natural healing mechanisms to take over.

In contrast, the Western explanation of acupuncture incorporates modern concepts of neuroscience. According to the National Institutes of Health, researchers are studying at least three possible explanations for how acupuncture works:

• Opioid release. During acupuncture, endorphins that are part of your body's natural pain-control system may be released into your central nervous system — your brain and spinal cord. This reduces pain much like taking a pain medication.
• Spinal cord stimulation. Acupuncture may stimulate the nerves in your spinal cord to release pain-suppressing neurotransmitters. This has sometimes been called the "gate theory."
• Blood flow changes. Acupuncture needles may increase the amount of blood flow in the area around the needle. The increased blood flow may supply additional nutrients or remove toxic substances, or both, promoting healing.

Who is acupuncture for?

Acupuncture seems to be useful as a stand-alone treatment for some conditions, but it's also increasingly being used in conjunction with more conventional Western medical treatments. For example, doctors may combine acupuncture and drugs to control pain during and after surgery.

Because of the difficulty of conducting valid scientific studies of acupuncture — numerous past studies have been proved inadequate — it's hard to create a definitive list of the conditions for which acupuncture might be helpful. However, preliminary studies indicate that acupuncture may offer symptomatic relief for a variety of diseases and conditions, including low back pain, headaches, migraines and osteoarthritis. In a 2006 Mayo Clinic study, acupuncture significantly improved symptoms of fibromyalgia.

In addition, research shows acupuncture can help manage postoperative dental pain and alleviate chemotherapy-induced nausea and vomiting. It also appears to offer relief for chronic menstrual cramps and tennis elbow.

Pros and cons

As with most medical therapies, acupuncture has both benefits and risks. Consider the benefits:

• Acupuncture is safe when performed properly.
• It has few side effects.
• It can be useful as a complement to other treatment methods.
• It's becoming more available in conventional medical settings.
• It helps control certain types of pain.
• It may be an alternative if you don't respond to or don't want to take pain medications.

Acupuncture isn't safe if you have a bleeding disorder or if you're taking blood thinners. The most common side effects of acupuncture are soreness, bleeding or bruising at the needle sites. You might feel tired after a session. Rarely, a needle may break or an internal organ might be injured. If needles are reused, infectious diseases may be accidentally transmitted. However, these risks are low in the hands of a competent, certified acupuncture practitioner.

How to choose an acupuncture practitioner

In the United States, acupuncture services are offered by two types of medical professionals:

• Medical doctors. About 3,000 medical doctors use acupuncture as part of their clinical practice. Most states require that these doctors have 200 to 300 hours of acupuncture training in addition to their medical training.
• Certified acupuncturists. About 11,000 certified acupuncturists who aren't medical doctors practice acupuncture in the United States. To be fully certified, these professionals complete between 2,000 and 3,000 hours of training in one of several independently accredited master's degree programs. They also must successfully complete board exams conducted by a national acupuncture accreditation agency, the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).

If you're considering acupuncture, do the same things you would do if you were choosing a doctor:

• Ask people you trust for recommendations.
• Check the practitioner's training and credentials.
• Interview the practitioner. Ask what's involved in the treatment, how likely it is to help your condition and how much it will cost.
• Find out whether the expense is covered by your insurance.

Don't be afraid to tell your doctor you're considering acupuncture. He or she may be able to tell you about the success rate of using acupuncture for your condition or recommend an acupuncture practitioner for you to try.