The Evidence for Acupuncture

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Acupuncture is a 5,000-year-old healing practice used to treat such diverse conditions as pain, digestive problems, respiratory disorders, anxiety, depression, headaches and migraines. Is there a place for this ancient approach in modern medicine? Acupuncturist Christine Kaiser, MS, LAc, LCH, FABORM, of the UH Connor Integrative Health Institute, describes two recent studies – one comparing acupuncture to intravenous morphine in the ER, the other on whether acupuncture is more than just a placebo effect – that provide some compelling evidence of the therapy’s effectiveness.

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Podcast Transcript

Pete Kenworthy

I've got a pain in my neck and, unfortunately, I'm not talking about a saying or something I can easily get rid of. I have an actual pain in the bottom of my neck, top of my back, and it just flared up again. I have a herniated disc, and it's something I've dealt with for years, not chronic pain. It's more like intermittent pain, and I would love to find a cure for it.

Macie Jepson

No pain meds though? Not thinking about that?

Pete Kenworthy

I'm not a pain med guy. Sometimes steroids maybe.

Macie Jepson

Yeah.

Pete Kenworthy

But I'd love to just have it go away.

Macie Jepson

Hydrocodone, oxycodone, I mean, that's what that's for, right? The pain. But if you don't fix it, then eventually you're going to build up resistance to the drugs, and then it's followed by a risk of dependence and addiction. I mean, that's what we hear so much about these days. And people either live with the pain, because they're afraid of the drugs or they risk becoming addicts.

Pete Kenworthy

Yeah. That's particularly scary these days, right? The opioid crisis. A big, big public health emergency. Ten point three million people misused prescription opioids in 2018, and 130 people died every day from opioid related drug overdoses. I don't think I want pain meds.

Macie Jepson

You know what? You should try acupuncture. Hi, everybody. I'm Macie Jepson.

Pete Kenworthy

I'm Pete Kenworthy. And this is Healthy@UH. Acupuncture. Huh? Isn't that, I'm kind of a skeptic here. I gotta be honest with you. Isn't that like the ancient voodoo medicine? Isn’t that what that is?

Macie Jepson

Well, ancient, yes.

Pete Kenworthy

OK.

Macie Jepson

Needles, yes, but not into a doll. So, you know, they can actually, this can actually help. I've had it before. For stress relief. I had fertility issues after my first children were born. But for the purpose of this conversation and pain, I also had acupuncture for whiplash, took it away in one treatment.

Pete Kenworthy

Wow.

Macie Jepson

But increasingly it's being used as an alternative to opioids for pain management,

Pete Kenworthy

University Hospitals acupuncturist Christine Kaiser from the Connor Integrative Health Institute joins us today to separate fact from fiction. Thanks for joining us.

Christine Kaiser, LAc, DACM

Thank you for having me.

Pete Kenworthy

So, let's talk about the facts here. There is science behind this, right? I read in some cases, acupuncture can actually be more effective than morphine when treating pain.

Christine Kaiser, LAc, DACM

That's right. We do have a lot of evidence, a growing body of evidence, that's accumulating right now. We're particularly looking at how acupuncture can treat chronic pain. And we're seeing some great results, including there was a study done comparing acupuncture to intravenous morphine in the emergency department. They were looking at severe pain cases, and they considered a success if pain was reduced by at least 50 percent. And when they compared the two side by side, acupuncture had a 92 percent success rate while morphine had a 78 percent success rate. They also looked at the amount of time it took to reduce pain, and the average amount of time for acupuncture was 16 minutes while morphine was 28 minutes. Additionally, they looked at adverse events that happened with using each intervention, and morphine had a 56 percent minor adverse event happen, and acupuncture had a 2.6 percent.

Pete Kenworthy

Wow. What kind of pain are you talking about here? Are we talking about chronic back pain, migraines, cancer related pain? I mean, what kind of, what kind of stuff are we talking about? My, my herniated disc, I mean…

Christine Kaiser, LAc, DACM

Really, really all of it. We're seeing help with acute pain, chronic pain, musculoskeletal pain, injuries, chronic pain, like osteoarthritis, nerve pain, like peripheral neuropathy that we see after people take chemotherapy or related to diabetes. All sorts of pain we can help.

Macie Jepson

And we talked about the opioid epidemic and people looking for alternatives. Are you seeing that here at Connor?

Christine Kaiser, LAc, DACM

Absolutely. We've been involved with the Pain Institute and with opioid committees trying to help bring another treatment modality in that's non-pharmacologic pain management. The joint commission a few years ago actually required hospitals to offer non-pharm pain treatment options. So, we're actually utilizing acupuncture throughout our UH system. We've done pilot programs in the emergency department to help reduce pain. We're doing pilot programs in postsurgical units, like the total joint replacement at Ahuja to help reduce pain and try to avoid those times when opioids are prescribed the most.

Pete Kenworthy

So, walk me through this, because as you heard me say, I'm a skeptic, right? And I'm sure you encounter people like me all the time. What does it actually do to help with pain? What does it feel like? Right? Because Macie and I talked before this conversation about she's had it before, and one time she actually flinched with the pain, right?

Macie Jepson

I did. Well, I did. It was at the top of my head, and it hit a nerve and, and it flinched. But that, that doesn't usually happen, right?

Christine Kaiser, LAc, DACM

Not usually. The needles are very tiny. They're about the size of a hair. I insert them with a tube, so they go through the skin very, very quickly. And that way I can also ensure the needle is sterile and clean, so it's never touching my hands before it enters the skin. And we use about 10 to 20 needles during a treatment. Most people actually don't feel them go in. They’re surprised that the first needle actually went in. And what we're seeing when we add acupuncture to a body is that the body becomes less sensitive to pain. We are identifying several routes that this is happening through. One is the peripheral and central nervous system, so possibly we're blocking pain signals getting to the brain. We're also seeing changes in the neurochemicals in the brain, so there's a release of endorphins which are natural opioid-like pain relieving chemicals. Most people also feel very happy and enjoy the acupuncture treatment probably because of the endorphin release and the time for relaxation. We're also seeing increased blood flow where we put needles. So, blood carries with it all of the things that heal our body: oxygen, nutrients, the immune system. And if we increase blood flow to an area that helps your body heal itself more naturally.

Macie Jepson

It's interesting you mentioned the endorphins because I've described to people before that you walk out afterward and the blues are bluer and the greens are greener. The sky is blue. You really do feel that way.

Christine Kaiser, LAc, DACM

Yeah.

Macie Jepson

But, let me, now I'm going to be the skeptic. Is there a placebo effect here? I mean, in the studies, could you kind of go there a little bit for us?

Christine Kaiser, LAc, DACM

Sure. There have been research studies done on acupuncture showing that there is more than just a placebo effect. So, there was a research study done on, I believe, 19,000 patients. They gathered a bunch of studies and looked at them together. It's called a meta analysis, and it showed that acupuncture was effective for chronic pain of things like osteoarthritis of the knee, neck pain, back pain. And the effect was more than just a placebo. So, we do have research now backing that up,

Pete Kenworthy

If you could tell me a little bit more just so I understand it. It goes very shallow into the skin, I think, right? How deep does it go? And I don't want people to get grossed out here.

Christine Kaiser, LAc, DACM

Sure.

Pete Kenworthy

I'm just trying to figure out, and are there specific parts of the body, like is there a map of the body that putting it in this part of your hand or in this part of your head or in this part of your torso, those trigger certain things? Does it work like that or am I making that up?

Christine Kaiser, LAc, DACM

Yeah, that's true. We, we can treat locally where pain is, but sometimes we treat what's called distally. So, for example, this week I treated somebody for neck pain they were having for a couple of weeks. I put two points in each hand and I told her to walk around a little bit and move her neck. And within about five minutes she was pain free and shocked, quite, quite honestly. And so, we do have a variety of ways to approach treating pain. There are 361 acupuncture points in the body. I would say we probably use more regularly about a hundred of those. But the insertion is pretty shallow. We are looking to go into muscle tissue. And when in the hands of a skilled provider, somebody with extensive training, it is very, very safe. There's very little adverse events like we saw in the morphine study. And it's a great way to help address pain.

Macie Jepson

Here we are at the Connor Integrative Health Institute, and the word is integrative. Could you tell me the difference between alternative medicine and integrative? Because we're hearing a lot about alternative medicine.  

Christine Kaiser, LAc, DACM

Right. That's a great question. So, alternative medicine is considered some form of medicine that's used instead of traditional Western medicine. Integrative medicine, we are looking to use evidence-based therapies. So, looking at trying to follow the research and what's being shown to work and using all available modalities that we have. So, somebody can be receiving surgery and get acupuncture concurrently. They can be on medication and work with a chiropractor here at Connor. And those are our ways that we're using integrative medicine, truly integrating throughout the system and trying to stay evidence-based while we do that.

Pete Kenworthy

And is it covered?

Christine Kaiser, LAc, DACM

For a lot of therapies, we are seeing more and more coverage. Chiropractic is fully covered. We have integrative medicine consultations where a patient can meet for an hour with a provider and discuss their healthcare and what their goals are, and that's covered. Acupuncture is covered for UH employees. And we're looking next year to try and expand that since we are seeing more and more coverage for patients with their acupuncture benefits for insurance. Right now, they can call and ask about their out of network benefits, and several of them are being reimbursed.

Macie Jepson

Can we talk a little bit more about chronic pain? Because that is what we are hearing is linked to this opioid crisis in our country. Are you saying that these modalities can really get into the root issue of chronic pain and be a game changer for people?

Christine Kaiser, LAc, DACM

Yes. We're seeing more and more that chronic pain is not only a physical problem in the body, but maybe the brain is involved, too. And we're trying to change how the body and the brain interact with the pain. And acupuncture is great, like I mentioned, at working on both of those things; the nervous system, blood flow as well as our brain chemicals to try and stop that chronic pain signal that keeps happening in the body.

Pete Kenworthy

So, more skeptic questions, right? What’s the training you receive for this? You're a licensed acupuncturist, right? What does that mean?

Christine Kaiser, LAc, DACM

Correct. I'm a licensed acupuncturist by the State Medical Board of Ohio. And it's a three and a half year Master's degree program. We also are required to take four national board certification tests. We are also required to have continuing education as we go along to get relicensed. And there's a move in the profession for it to become a four-year doctorate degree. So, this year I actually completed my doctorate in acupuncture and Chinese medicine.

Macie Jepson

So, it is important that patients have serious conversations with their providers about their background experience, et cetera.

Christine Kaiser, LAc, DACM

Absolutely. And it's great for patients to know there's a few ways that they can receive acupuncture treatments. We offer private acupuncture sessions. They're one-on-one with a provider in a private room. But we also offer group acupuncture to make it more affordable. This is the style of acupuncture that's done commonly in China, and you're in a shared room, but you rest quietly; you're fully clothed, and we're able to still address your chief complaint.

Pete Kenworthy

OK. Dr. Christine Kaiser, licensed acupuncturist from University Hospitals. Thanks so much for your time. We appreciate the insight.

Christine Kaiser, LAc, DACM

Thank you very much for having me.

Pete Kenworthy

Remember, you can find and subscribe to this podcast on iTunes, Google Play, Stitcher, or wherever you get your podcasts. Search University Hospitals, or Healthy@UH, depending on where you subscribe.

Macie Jepson

And as always, for more health news, advice from our medical experts and Healthy@UH podcasts, go to UHhospitals.org/blog.