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An Acupuncture Equation

Does it add up?

Sarah Schaefer

+

 

 

=

 

 

 

Stress

 

Acupuncture

 

Relaxation

                                                                               

 

 

Acu-what?

An alternative treatment born of the ancient Chinese medical tradition, acupuncture is a common procedure in many Asian countries and is currently gaining a following in the United States as well. According to prevailing Eastern theory, life is sustained by qi, a vital energy that flows throughout the body, facilitating such physiological processes as digestion and circulation. (Bartlett, 2004)

This energy flow, however, is severely disrupted by stress. A natural response to any number of situations, stress activates the body’s sympathetic nervous system, which in turn initiates a “fight or flight” response. As a result, digestion is slowed, both breathing and heart rates are increased, and vasodilatation occurs. Additionally, the body releases a number of hormones, including cortisol. Such a response, however, is often inappropriate given the benign nature of the stress-inducing situations we most commonly encounter. Further, chronic stress may negatively impact one’s health. Persistent and elevated levels of cortisol are associated with immunosuppression, hypertension, decreased memory functioning, depression, and severe headaches. These symptoms are allegedly the result of a blocked flow of qi, which creates pressure and tension in the affected area. The web claims that acupuncture relieves this tension, thereby reducing stress and the presence of its associated symptoms. (http://www.acufinder.com/Acupuncture+Information/Detail/Acupuncture+for+Stress+and+Anxiety)

 

Web claims:

The proposed effect of needles on stress

How does acupuncture relieve such tension? How might a needle reduce, as opposed to generate, anxiety? It seems somewhat oxymoronic. According to prevalent web information, the answer is explained by both Eastern and Western schools of thought. In terms of the former, the piercing of the skin provides an escape valve through which the stopped-up qi may flow, alleviating stress-induced symptoms. (Bartlett, 2004). The body consists of over 2000 acupuncture points at which such valves exist. They vary in name from “Abdominal Bind” and “Celestial Window” to “Zygoma Crevice” (http://www.acufinder.com/Acupuncture+Points).

From a Western and more clinical standpoint, however, the procedure causes the brain to release natural pain-killing chemicals called endorphins. Endorphins act to increase circulation and the oxygenation of tissues, thereby facilitating the removal of bodily toxins and waste. In addition, they cause muscle relaxation and a decrease in heart rate and blood pressure (http://www.acufinder.com/Acupuncture+Information/Detail/Acupuncture+for+Stress+and+Anxiety). Within our cultural framework, this explanation appears more valid.

Admittedly, there are few risks and side effects associated with acupuncture. The FDA has established a set of standards to which manufactured needles must conform. These regulations pertain primarily to sterility, toxicity, and proper labeling. The majority of complications reported result from the improper insertion of needles and the use of poorly sterilized equipment. Associated risks, though rare, can be serious and include infection and the piercing of an organ (http://nccam.nih.gov/health/acupuncture/#risks).

 

Ulterior motives or truth?

In light of the severity of potential side effects, what studies have been conducted to assess this stress-relieving claim? In other words, is it work the risk? The National Center for Complementary and Alternative Medicine (NCCAM) reveals that a Consensus Statement produced by the National Institutes of Health (NIH) in the late 90’s concerning the efficacy of acupuncture was largely inconclusive. Most recently, the site states that studies are aimed at assessing different aspects of the treatment, including its organic mechanism, the neurological features of acupuncture points, and the health conditions for which the procedure is effective (http://nccam.nih.gov/health/acupuncture/#status).

Text Box: Auricular Acupuncture Points
www.yinyanghouse.com/ taxonomy/term/66

            A study found in New Life Journal analyzes the effectiveness of auricular acupressure in reducing anxiety among patients being transported in an ambulance. In each of the 36 subjects, stress was measured via a visual analog scale. In those who received acupressure at the proper relaxation point, anxiety was reduced from 37.6 to 12.4. However, for those patients who received acupressure at a sham point, anxiety increased from 42.5 to 46.7 (Bartlett, 2004).  Though the article presents such findings as conclusive evidence in support of the stress-reducing ability of acupuncture, a few questions must be addressed. It is particularly important to assess potential confounds that may have contributed to a reduction in anxiety. For instance, what was the demeanor of the individual administering the acupressure treatment? Was it consistent across trials? Also, what was the nature of the patient’s health? Did the severity of patient conditions vary across subjects? An individual with a more serious ailment would likely be less able to relax. Further, a visual analog scale is largely ineffective in analyzing differences between groups. It is a subjective form of measurement; interpretations vary considerably among subjects. One must also wonder if acupressure is comparable to acupuncture. Are the two truly interchangeable? Does the simple application of pressure at a particular point cause the brain to release the same chemicals, and in similar amounts, as when a needle is used? Ultimately, the article fails to address these concerns.

In addition to the information provided above, acupuncture.com presents an overwhelming supply of research article summaries pertaining to the effects of acupuncture on cancer, coronary heart disease and hypertension, pain, immune functioning, psychological disorders, and many more (http://www.acupuncture.com/research/). Each summary stands in support of the treatment. The website, however, is geared specifically towards advocating acupuncture, and as a result, this support can be expected. In addition, the journal in which the research was allegedly published is not listed. This raises a number of doubts concerning the validity of the studies. Therefore, the question still remains. Is there sufficient empirical evidence to support or disprove the acupuncturist’s theory?

            Admittedly, the sites are largely legitimate. For instance, acupuncture.com acts as a source for potential clients, providing a list of local practitioners, necessary credentials, as well as a considerable amount of information concerning both the clinical and traditional aspects of the treatment. Acufinder.com offers similar information, even detailing the laws and legislation regulating licensure and practice in each state (http://www.acufinder.com/Acupuncture+Laws). The NCCAM is a subsidiary of the NIH (National Institutes of Health) within the U.S. Department of Health and Human Services (http://nccam.nih.gov/about/ataglance/). Therefore, this source provides perhaps a more objective view of acupuncture. Overall, however, each website is attempting to promote the practice, to win over customers. As a result, there may be a slight manipulation of the information presented, or at least a failure to present evidence that may lie contradictory to their claims. It is therefore important to review the scientific literature in order to evaluate these assertions.

 

Consulting the science:

Does acupuncture reduce stress?

Text Box: “Extra 1” or Yingtang Point
http://www.accupuncture.com/.../ extrapoints/yintang.htm
                A number of studies have been conducted in an effort to uncover any potential correlation between lowered stress and the use of acupuncture, albeit to little or no avail. In a study conducted by Fassoulaki et al. (2003), 25 volunteers, both male and female, of good health and with no prior exposure to acupuncture, were divided into two groups. One received pressure at extra 1 or Yintang point located midway between the eyebrows and the other at a control point. Pressure was applied by the thumb of the experimenter for 10 minutes in the extra 1 group and for only 5 minutes in the control group because the sensation was found to induce pain. Measures included a self-report on behalf of the volunteer, in which the subject was asked to score his or her stress and tension based on a 10-point verbal stress scale. Also, an electrode was attached to the forehead and recorded BIS values, a measure commonly used to assess level of consciousness during anesthesia. Both the inventory and the electrode measurements were taken prior to and following the administration of pressure to the selected point. It was found that both BIS and VSS values were reduced by 50% in those receiving pressure at the extra 1 point, indicating a reduction in stress and an increase in relaxation.

However, such results must be viewed with a critical eye. The form of stress assessed in the experiment was preoperative stress. It is unclear how this specific type of anxiety may relate to that which is experienced routinely. Further, self-report is not an entirely accurate form of measurement. Aware of the nature of the study, volunteers may have felt more inclined to record a reduction in stress following the treatment. The use of physiological measures, as opposed to self-report, may provide greater insight into the effects of acupuncture.

Wang and Kain (2001) employed such measures while testing to see the effects of auricular acupuncture on acute anxiety. A collection of 55 volunteers was divided into 3 groups, each receiving acupuncture at the specified location: the Shenmen point group, the relaxation point group, and the sham group, which received acupuncture at a location that was not documented to induce any relaxation effects. In addition to providing a State-Trait Anxiety Inventory (STAI) that measured baseline and situational anxiety and a Life Experiences Survey that assessed the severity of various events encountered throughout the previous year, blood pressure, heart rate, and electrodermal activity, which evaluates changes in skin conductance as caused by sweat glands ,were recorded. These physiological measures are frequently cited as psychological indices of stress in psychology (549). The needle remained in the designated location for 48 hours, measurements taken after 30 minutes, 24 hours, and 48 hours. The only significant result, however, was found to be based on the STAI. Subjects in the relaxation group were less anxious at 30 minutes and 24 hours than those of the Shenmen and sham groups, and at 48 hours as compared to the Shenmen group. There were no group differences or time interaction differences in electrodermal activity, blood pressure, or heart rate. Perhaps a number of confounds may have contributed to this result. As the authors state, at the onset of the experiment, the volunteers were not greatly stressed. Therefore, a reduction in anxiety would likely be less visible. Also, the nature of anxiety experienced by each subject varied as he or she continued with normal daily activities. The anxiety was not controlled in an experimental manner. Regardless, the results are not in support of a reduction in the physiological markers of stress.

 

Proposed mechanism of action

                In a paper published by Leong and Chernow (1988), analyzing the probable mechanisms by which acupuncture acts in reducing stress and pain sensations, the following are listed:

 

1.      Placebo effect. The administration of treatment creates an expectation on part of the participant, which in turn produces the observed effect.

2.      Gate-control theory. The stimulation of various acupuncture points produces an increase in pain threshold, thereby requiring greater signals to produce a painful sensation.

3.      Increased plasma endorphin levels. Levels may be high due to increased production, decreased post-synaptic elimination, or decreased binding to receptors.

 

Therefore, according to the above theories, acupuncture likely acts through the modulation of brain chemistry, and more specifically, through elevated levels of plasma endorphins. The role of such endorphins in the stress response was described by Amir, Brown, and Amit (1979) as producing changes in emotional-tone and an analgesic effect, modifying pain responsiveness (79). Further, such pain responsiveness was found to be reduced in instances of prolonged exposure to stress, indicating a chronic reduction in the functional availability of endorphin (79).  It is therefore clear that elevated endorphin levels may lead to a reduction in experienced anxiety. This agrees with the information located on the web. However, does acupuncture produce these proposed elevated levels?

The literature is largely contradictory. Leong and Chernow (1988) cite a number of studies, such as that conducted by Facchinetti and colleagues, who found that increased plasma B-endorphin concentration and decreased plasma cortisol, with no change in ACTH (which is believed to increase with increased levels of endorphins) following a 20-30 minute acupuncture session (as cited in Leong & Chernow, 1988, p. 215). The research of Lee and colleagues was similar in methods, but produced different results. After the administration of treatment, there was no increase in plasma dopamine (a chemical producing physiological effects similar to endorphins) levels, but a significant increase in plasma cortisol concentrations (as cited in Leong & Chernow, 1988, p. 214). There has yet to be a consensus on the matter. This is largely due to a lack of cohesive and effective experimental designs, as well as accurate forms of measurement.

 

Verdict

The jury is still out when it comes to the effectiveness of acupuncture in reducing stress. Granted, the web is willing to claim otherwise, promoting the service as a beneficial and essentially harmless treatment for anxiety, and a number of other ailments. Though they provide a considerable amount of information concerning the history of acupuncture, current state laws and regulations, and the logistics of needle insertion, they largely fail to provide a supply of supportive scientific evidence. 

After consulting several scholarly journals, however, the reason behind this omission is made clear. The body of evidence that does exist is largely contradictory. Take for instance those studies presented by Leong and Chernow (1988). In one experiment, the results indicated increased plasma concentration of endorphins, while in another, the concentrations in fact decreased. There appears to be a profound reliance on self-reported data as opposed to physiological measures, which often fail to yield significant results. This was plainly the case in the Wang and Kain (2001) study on the effects of auricular acupuncture on acute anxiety. The results indicated no differences in pre- and post-treatment measures of blood pressure, heart rate, and electrodermal activity, which are common physiological markers of stress. Perhaps a failure to reach consensus among research aimed at acupuncture results from a subjectivity of terms. For instance, what is stress? How can it be measured or experimentally manipulated?

At the end of the day, the decision lies in the hands of the individual. Self-reports generally indicate a reduction in stress, and regardless of the physiological mechanism by which acupuncture acts, this fact remains of ultimate importance. It is the feeling and subsequent wellbeing of the individual who receives treatment that matters most. Therefore, if he or she feels more relaxed following an acupuncture session, for all practical purposes, the treatment lived up to its claim. Given that the risks and side effects associated with acupuncture are rare, if someone is genuinely open to the idea of treatment, I would simply recommend seeking an experienced practitioner.

 

References

 

Amir, S., Brown, Z.W., & Amit, Z. (1979). The Role of Endorphins in Stress: Evidence and

Speculations. Neuroscience & Behavioral Reviews, 4, 77-86.

Bartlett, K. (2004). Acupuncture: the stress-buster. New Life Journal. Retrieved October 1, 2008,

from

http://findarticles.com/p/articles/mi_m0KWZ/is_5_5/ai_n6170917/pg_2?tag=artBody;col1

Fassoulaki, A., Paraskeva, A., Konstantinos, P., Pourgiezi, T., & Kostopanagiotou, G. (2003).

Pressure Applied on the Extra 1 Acupuncture Point Reduces Bispectral Index Values and Stress

in Volunteers. Anesthesia & Analgesia, 96 (3), 885-9.

Leong, R.J., & Chernow, B. (1988). The effects of acupuncture on operative pain and the

hormonal responses to stress. International Anesthesiology Clinics, 26(3), 213-17.

Wang, S., & Kain, Z.N. (2001). Auricular Acupuncture: A Potential Treatment for Anxiety.

Anesthesia & Analgesia, 92(2), 548-53.

 

 

 

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