Power points

Judy Becker Worsley’s rapid recovery from an accident last summer astounded her or- thopedic surgeon. A truck ran over her foot and crushed it. Her surgeon told her she’d be in a cast for at least six weeks. Worsley decided to try acupuncture to help ease the pain after surgery. “I always use natural treatments first,” says Worsley, who’s 60 and lives in a 16th-century farmhouse within the small hamlet of Burton Dassett in England’s rolling rural Midlands. “If they don’t help and I need painkillers, I would happily use them.” For several weeks after her surgery, Worsley received weekly treatments in which special needles were applied to both sides of her body at four or five acupuncture points associated with easing pain. Not only didn’t she need conventional pain medication, she was out of the cast in nine days.

Although Worsley still took advantage of antibiotics and other conventional medical treatment, her pain had subsided so much that she could bear weight on her foot long before her surgeon expected it. “He was amazed,” she says. But he scoffed when she credited acupuncture with alleviating the pain. “He said, ‘I don’t believe in that, so you must have a very high threshold of pain,’” Worsley recalls. “He just couldn’t understand how acupuncture could work.”

Worsley’s surgeon is not alone. Few physicians claim to know exactly how acupuncture works, but growing evidence shows it does—as an effective treatment for everything from pain to nausea to infertility. The World Health Organization lists 40 conditions—including lower back pain, anxiety and arthritis—for which acupuncture is an appropriate treatment. In 1997, the U.S. National Institutes of Health issued a consensus statement recognizing acupuncture as a treatment for pain following dental surgery and nausea induced by surgical drugs and chemotherapy. It also believed that acupuncture might be useful in treating asthma, headaches, addiction and the debilitating muscle pain and fatigue associated with fibromyalgia. Acupuncture is not yet mainstream, but more and more people do seem to be getting the point.

Acupuncture originated in China at least 2,500 years ago. It’s based on the theory that vital energy or “qi” flows along 14 meridians connecting organs and vital systems in the body. According to this theory, imbalances in the opposing aspects of yin (feminine, cool, receptive) and yang (masculine, warm, dominant) disrupt the flow of qi and cause illness.

Today, traditional Chinese medicine (TCM) often combines acupuncture with herbs, exercise and lifestyle changes to restore the balance between yin and yang, and therefore the healthy flow of qi. Practitioners carefully observe and question each patient and then apply hair-fine needles and sometimes heat to specific therapeutic points along the meridians. For example, an acupuncturist might treat hypothyroidism—a condition characterized by low levels of thyroid hormone and symptoms including hair loss, constipation and feeling cold and sluggish—as a yang deficiency. The prescription might include applying acupuncture to two primary points on the back and four more on the front of the body, and burning an herb called moxa at the end of the needles to stimulate yang’s warming energy.

Acupuncturists treat each patient as a unique individual, which means people who are diagnosed with the same illness by Western standards might receive different treatments from TCM practitioners. While Western medicine focuses on particular symptoms and causes of disease, TCM seeks to treat “patterns of disharmony,” notes Harvard Medical School Assistant Professor Ted Kaptchuk in his seminal book The Web That Has No Weaver: Understanding Chinese Medicine. He observes that in Chinese medicine, “One does not ask ‘What is causing Y?’ but rather, ‘What is the relationship between X and Y?’”

Ever since acupuncture began spreading throughout the West in the 1970s, scientists have been searching for a physiological basis for its effects. Some studies have found acupuncture stimulates the release of endorphins, the body’s natural painkillers. Other research in animals and humans suggests acupuncture affects areas of the brain involved in the perception of pain. Studies also have found acupuncture can improve circulation.

In Worsley’s case, acupuncture not only eased pain, but eliminated the need to experience the potential side effects of painkillers. She was not surprised by acupuncture’s efficacy though. She practises the technique herself and serves as education director at the Worsley Institute, which teaches classical acupuncture techniques and was founded by her late husband, J.R. Worsley, who brought one of the most ancient forms of acupuncture from China to the West in the 1950s.

Dr. Tong Joo Gan, an anaesthesiologist who also trained in TCM, is investigating acupuncture’s effects on people like Worsley who experience pain following surgery. Gan and his colleagues at Duke University Medical Center found that patients who receive acupuncture before and during surgery have less pain afterward and need fewer painkillers than those who receive only pain medication. Their findings are based on an analysis of 15 randomized controlled trials.

“Using less morphine reduces all the nasty side effects of opioids, including nausea and vomiting, itchiness, drowsiness and urinary retention,” says Gan, who reported the team’s findings at the American Society for Anesthesiology’s 2007 conference. He adds that these side effects can slow healing and lengthen hospital stays.

Two large-scale German studies suggest acupuncture can also help ease two of the most common forms of chronic pain: arthritic knees and achy backs. Dr. Hanns-Peter Scharf and his colleagues at the University of Heidelberg reported in the July 4, 2006, issue of the Annals of Internal Medicine that combining acupuncture with the standard treatment for osteoarthritis of the knee reduces pain and improves mobility more than that treatment alone. Another German team, led by Dr. Michael Haake of the University of Regensburg in Bad Abbach, found acupuncture was nearly twice as effective as conventional therapy in treating chronic lower back pain.

Both these studies of more than 1,000 patients, however, come with an interesting caveat. No statistically significant difference was found between the improvement of subjects who received real acupuncture and those in control groups who received the “sham” version, administered at non-acupuncture points. Are the beneficial effects of acupuncture merely the result of the placebo effect?

“We know that patients benefit from getting treated,” says Ted Kaptchuk. “Is that benefit because of the physiological activity of acupuncture or the effect of a therapeutic ritual? It’s unclear at this point.”

As researchers probe such questions, people like Jennifer Woolf continue to seek acupuncture when conventional treatments fail. Woolf was a professional figure skater in her mid-20s when severe endometriosis, a condition in which uterine tissue grows outside the uterus and can cause excruciating pain and infertility, landed her in bed for a week every month. The crippling pain returned after surgery, leaving Woolf with a difficult choice: Live with the pain or undergo medically induced menopause at age 26. It was then she read in a book about endometriosis that acupuncture might help. She decided to give it a try.

“It didn’t make the cysts go away and my doctors told me that my disease meant I’d never have children,” says Woolf, now 38. “But as long as I have regular acupuncture, I don’t have pain or symptoms.”

Woolf’s experience moved her so deeply that she became an acupuncturist herself. Her words are precise and her tone is matter-of-fact as she recounts another acupuncture treatment that helped her. Three years ago, Woolf became pregnant—without fertility treatment—in spite of her doctor’s predictions.

Does she think acupuncture helped her conceive? “I think it reduced the size of the cysts a little bit, but more importantly it made my whole body feel better,” Woolf says. She adds that it also helped with morning sickness. “I had tried everything in the book, from the medication my doctor prescribed to taking more B vitamins, but nothing helped,” Woolf recalls. “After acupuncture, I still felt a little nauseous, but I was no longer lying on the floor sick to my stomach all morning.”

A study of nearly 600 pregnant women in Australia by Dr. Caroline Smith, a researcher at the Women’s and Children’s Hospital at Adelaide University, found acupuncture shows promise in treating morning sickness. Smith reported in the journal Birth in 2002 that giving pregnant women acupuncture once a week for four weeks reduced the nausea from morning sickness and that even one treatment could help them feel better.

Smith has also investigated whether acupuncture can improve pregnancy rates for women undergoing in vitro fertilization, a theory based on research suggesting acupuncture can increase blood circulation to the uterus and ovaries. Although the success rate was higher in women who received acupuncture in addition to IVF, the difference was small. But when researchers combined this study of 228 women and three other studies with a combined total of nearly 800 women, the results suggested pregnancy was twice as likely to occur in the acupuncture group.

For nearly every study suggesting acupuncture’s benefit, however, there is another that contradicts it.For instance, a smaller study of 97 IVF patients by Dr. LaTasha Craig of the University of Oklahoma found that women who received acupuncture had lower success rates of pregnancy.

Woolf and her husband Quentin now divide their time between raising their 3-year-old daughter and seeing patients at their acupuncture practise in Concord, New Hampshire. Whether acupuncture helped Woolf conceive remains unclear. Woolf, however, is convinced it helped. “Can I prove that acupuncture made a difference? No. But the years I’ve had this treatment and the years I’ve felt good coincide, so I think 100 percent that it played a role.”

To Worsley, who emphasizes that modern medicine, including antibiotics and surgery, were also key to her recovery, acupuncture’s power arises from its focus on living in harmony and balance within oneself and with the natural world. This, she says, is the ancient Chinese definition of health. “We really need to redefine health,” she says. “We’ve lost our way by focusing merely on trying to be symptom-free. That’s not what health is about. It’s about being well, having a sense of peace and flourishing.”

But does it hurt?

Always seek a licensed acupuncturist and ask if he or she has experience with the symptoms or illness you’re experiencing.
Here are some answers to a few other common questions:

Does acupuncture hurt?
Typically not. Unlike large and hollow hypodermic needles, acupuncture needles, made of stainless steel, are as fine as a human hair and solid. The most common sensations are a gentle tap or tingling.

How much does it cost?
The average acupuncture session in the U.S. and Europe runs between $50 and $100, with fees escalating upwards of $200. The rare insurer covers some acupuncture treatments. In Germany, research recently persuaded the government to cover acupuncture for lower back pain.

What happens at a session?
An acupuncturist will examine you based on the tradition he or she follows, often checking various pulses, the colour and texture of your skin and tongue, your speech and other criteria. The number of needles used depends on the diagnosis, but can range from one or two to more than 30. Chinese medicine practitioners may also apply heat and often prescribe additional herbs and lifestyle changes as part of an overall plan.

How many treatments are needed?
That depends on your condition and response, but treatment typically includes several sessions once a week. The goal, says acupuncturist Jennifer Woolf, is not to keep patients coming forever but to “get people to a place where they are functioning at a level where they can enjoy life.”