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Acupuncture in Relation to Rheumatoid Arthritis and Osteoarthritis
Introduction: Acupuncture is a form of alternative medicine used for relieving pain, anesthetizing patients for surgery, and for the prevention and treatment of disease. Acupuncture has been in existence for thousands of years in several Asian countries, but has not been recognized or practiced in the Western civilization until recently.
One of the many purposes of acupuncture is to restore the flow of qi (pronounced as chee.) The western civilization believes that qi is a kind of energy or “vital substance” that “serves as a life force and as the organizing principle flowing through all things and establishing their interconnectedness.” (http://www.holisticonline.com/Acupuncture/acp_philosophy.htm) Furthermore, the Chinese believe that all living things have qi, which can be “found in the heart and lungs in circulating blood and oxygen.”(http://www.holisticonline.com/Acupuncture/acp_philosophy.htm) Moreover, qi is part of the “three treasures,” which also include Shen, the spirit and Jing, our essence. The three treasures embody the philosophy of Dao, which promotes moderation, which includes “living in harmony with nature and striving for balance.” (http://www.holisticonline.com/Acupuncture/acp_philosophy.htm) The purpose of acupuncture is to restore health and enable a person to live by the philosophy of Dao.
Qi circulates throughout the body by invisible channels, called meridians. There are twelve main meridians; six that are considered ying and the other six are yang. Aside from the main meridians, there are many minor meridians that form a network. “Each meridian is named after an organ or function.” There are “eight extraordinary meridians that are thought to be reservoirs that supply blood and qi to the twelve regular channels.”
Location of the meridians and acupoints in the body.
The disruption of the flow of qi results in illness and pain. Acupuncture restores the flow of qi; therefore curing physical discomforts and illnesses. This kind of alternative therapy uses thin needles that are placed at various points throughout the body, called acupuncture points. To stimulate the points, techniques such as heat, pressure, friction, suction, or impulses of electromagnetic energy are incorporated. (http://www.holisticonline.com/Acupuncture/acp_what_is.htm)
How it works: Using a plastic tube as a guider, the needles are placed at the acupuncture points, which then produce endorphins, thus blocking the transmission of pain signals to the brain. The needles are also placed in areas that are tender, known as trigger points. On contact with the trigger points, the chronic pain experienced is minimized. It is theorized that the points contain electrical properties that can change neurotransmitters in the body when stimulated; thus inhibiting pain signals. (http://www.holistic-online.com/Acupuncture/acp_how_works.htm) (http://www.arthritis.com/4_9_2.asp)
Specifically, when treating rheumatoid arthritis, which is the inflammation in and around the joints, needles are used to stimulate the adrenals, which release natural anti-inflammatory steroids. The treatment for osteoarthritis, the wearing away of cartilage in joints along with creating deposits of calcium, utilizes the hair-like needles to stimulate the parathyroid glands. Upon contact with the glands, hormones are produced causing withdraw of calcium arthritic deposits from the bones. (http://www.acupuncturehealingarts.com/arthritis.html)
Claims: Overall, the web-sites claim that acupuncture alleviates pain caused by rheumatoid arthritis and osteoarthritis. Furthermore, because the endorphins and hormones initiated by the needle are naturally occurring, it is insured that there are no side effects from the treatment, although feelings of numbness, achiness, or tingliness can be experienced during the treatment. (http://www.acupuncturehealingarts.com/arthritis.html) (http://www.arthritis.com) Other web-sites claim that the cartilage that has been worn away by osteoarthritis cannot be restored, but after attending 6-10 acupuncture treatments, patients feel remarkably better, which enables them to move around pain-free. (http://www.flojo.demon.co.uk/pain.htm)
Evidence: Some sites state that after years of clinical trials, it has been suggested that acupuncture is an effective way of treating pain brought on by osteoarthritis. (http://arthritisinsight.com/medical/alternative/acupuncture.html) Furthermore, a study was carried out, where 32 patients inflicted with osteoarthritis, were treated using acupuncture, while waiting for knee surgery. The patients that were treated experienced less pain than those who were not treated; thus indicating the possible effectiveness of acupuncture. (http://www.tcwellness.com/issues/1998/04/17.html) Unfortunately, there was no evidence supporting the effectiveness of acupuncture towards rheumatoid arthritis. It has also been stated that once the joints reach a certain level of deterioration, acupuncture will not be as affective. (http://www.acupuncturehealingarts.com/arthritis.html)
Evidence Found in Medical Journals: Because the advertisers made a number of claims concerning the effectiveness of acupuncture therapy, a variety of medical journals were examined in order to find supporting or contradictory information concerning each claim.
Acupuncture and Rheumatoid Arthritis
The first study that was analyzed dealt with the effectiveness of acupuncture in treating rheumatoid arthritis. The study was conducted using a double-blind randomized placebo-controlled cross-over design. The study consisted of 56 patients ranging from the ages of 18-75 and was of 2nd line therapy. The treatment consisted of a single-point acupuncture of placebo, followed by a 6 week washout period. The data was then collected using inflammation markers, visual analogue scales of pain, global patient assessments, counts of swollen joints, and general health questionnaires. After assessing the results, it was concluded that acupuncture was not an effective addition to therapy in patients diagnosed with rheumatoid arthritis. To support the researcher’s conclusions, a review that examined 17 other studies concerning the effectiveness of treating rheumatoid arthritis with acupuncture also came to the same conclusion that acupuncture was not effective in treating patients with rheumatoid arthritis. This study and the review that was mentioned both disprove the claims the advertisers made concerning the effiency of acupuncture in treating people diagnosed with rheumatoid arthritis (David, Townsend, Sathanathan, Kriss, Doré, 1999).
Next, a randomized control clinical trial was carried out to determine whether “demographic, medical history, or arthritis assess data may influence the outcome and rate of decay for patients with osteoarthritis treated with acupuncture” (Singh, Berman, Bareta, Lao, Zarow, Hochberg, 2001). The study consisted of about 60 patients inflicted with symptomatic osteoarthritis of the knee. Each person, including the crossover control received treatment twice a week for 8 weeks. The data was then collected by using a self scoring mechanism on the Western Ontario and McMaster Universities Osteoarthritis Index at the baseline then at 4, 8, and 12 weeks. The final results demonstrated full relief from pain for those who were least disabled from the arthritis, while the more severe cases showed improvements rather than total relief from pain. Therefore, it was concluded that acupuncture is effective in treating patients inflicted with osteoarthritis, thus supporting the advertiser’s claim (Singh, Berman, Bareta, Lao, Zarow, Hochberg, 2001).
Furthermore, a review was written evaluating trials of acupuncture relating to osteoarthritis of the knee, while assessing the quality of each trial and determining whether there was a correlation between the quality of the trial and the outcomes of effectiveness. Using the Jadad scaled, sixty-two abstracts were utilized, along with randomized or quasi-randomized trials in any language to determine the quality of each case. The overall results indicated that acupuncture was effective in controlling pain, although some pain was also alleviated using sham acupuncture (Ezzo, Hadhazy, Birch, Lao, Kaplan, Hochberg, Berman, 2001).
Acupuncture and Endorphins
Other claims were also made by advertisers, stating that acupuncture initiated the release of endorphins. After further investigation the following was found: A meta-analysis was written proving through physiological trials and clinical trials that acupuncture was effective in treating pain. The article stated that acupuncture induces pain relief by releasing endorphins. Furthermore, “the induction of analgesia is accompanied by increased cerebrospinal fluid levels of beta-endorphin from the pituitary-hypothalamic region” (Bonta, 2002). Most importantly, the researcher found that promising effects were reported in musculoskeletal disorders, such as rheumatoid arthritis (Bonta, 2002).
The next review was written in which the researcher concludes that acupuncture effects the levels of Beta-endorphins. Clinical trials proved that acupuncture is effective in pain control. Experiments and clinical evidence suggests that “acupuncture may affect the sympathetic system via mechanisms at the hypothalamic and brainstem levels,” (Andersson, Lundeberg, 1995) this form of treatment also “releases endogenous opioids and oxytocin” (Andersson, Lundeberg, 1995). The researcher also mentions that acupuncture contains various diseases such as inflammation, pain, dysfunction of the autonomic nervous system, peripheral and central nervous systems. The researcher also takes into account that clinical trials are hard to conduct since placebos are hard to establish when studying acupuncture. Last, the author states that acupuncture “releases neurotransmitters and hormones” (Andersson, Lundeberg, 1995). This paper not only supports the claims made concerning acupuncture releasing endorphins, but also on the possible alteration acupuncture may have on neurotransmitters. Arthritis is an inflammatory disease which causes severe pain, therefore, the review also supports the claim concerning the treatment of pain experienced in arthritis (Andersson, Lundeberg, 1995).
Next, a study was performed which focused on finding the “action of acupuncture stimulation on analgesia” (Peng, Yang, Kok, Woo, 1978). The experiment utilized brain serum extracts of acupunctured rabbits that was then injected into other rabbits. By injecting the rabbits with the serum, there was an increase on pain thresholds. The researcher concluded that acupuncture stimulates the release of endorphins which inhibits feelings of pain (Peng, Yang, Kok, Woo, 1978).
The last study dealt with trying to find out how and if acupuncture-like stimulation of anesthetized rats influence the adrenal medullary catecholamine secretion. Moreover, the study tried to determine the reflex pathway (if any) in the afferent limb, efferent limb, and reflex limb. To test these questions, acupuncture needles were placed in the skin, underlying muscles of either the abdomen or hind limb pathway of the rats. The rats containing spines experienced increase in the catecholamine secretion and nerve activity. Overall, the experiment proved that acupuncture effects the levels of adrenal medullary hormones. The influence of acupuncture is explained by “the excitation of somatic afferent nerves and by the reflex response of adrenal sympathetic efferent nerves” (Sato, Sato, Suzuki, Uchida, 1996). In essence, this study supports the claim that advertisers made that acupuncture stimulates the adrenal glands (Sato, Sato, Suzuki, Uchida, 1996).
Who is presenting and why: The majority of the web-sites belonged to doctors or companies that are promoting acupuncture by educating the reader through the use of questions and answers. (http://www.acupuncturehealingarts.com/arthritis.html) By answering questions, the promoters hope to lure arthritis inflicted patients into trying acupuncture to cure their ailments.
Conclusions: Overall, I found that the information presented was somewhat credible. After reviewing the various studies, I believe that acupuncture is effective in minimizing pain brought on by osteoarthritis. On the other hand, I do not believe that acupuncture is effective in treating patients that are inflicted with rheumatoid arthritis. In addition, acupuncture is a very safe treatment; nowhere was there a case in which the treatment caused major or minor injury. For the most part, the studies seemed to have little if any research bias; some of the researchers used the double-blinded study technique in hopes of obtaining the most accurate results. Last, the use of acupuncture as a pain relief mechanism is very credible, in that the majority of the studies carried out testing the effectiveness of acupuncture concluded the release of endorphins thus inhibiting pain receptors.
-Acupuncture points: the locations where the qi of the channels rises close to the surface of the body, a total of 400 points.
-Ying yang: the idea that every person is managed by adverse yet complementary forces.
-Yin: dark, passive, feminine, cold, and negative.
-Yang: light, active, male, warm, and positive.
-Double-blind study: a technique designed to prevent observer-and participant- expectancy effects in which neither the researcher nor the subjects know the true purpose of the study or which subject is in which condition.
-Endogenous opioids: substances made by the body to fight pain.
-Oxytocin: synthetic hormone that indirectly stimulates uterine smooth muscle contractions and helps expedite the normal contractions of spontaneous labor. (http://www.nycremsco.org/protocols/drugs/Oxytocin.htm)
-Analgesia: A deadening or absence of the sense of pain without loss of consciousness. (http://www.dictionary.com/)
-Medullary catecholamine secretion: any of a group of chemically related neurotransmitters, as epinephrine and dopamine that have similar effects on the sympathetic nervous system. (http://www.infoplease.com/ipd/A0364889.html)
David, J., Townsend, S., Sathanathan, R., Kriss, S., & Doré, C. J. (1999). The effect of acupuncture on patients with rheumatoid arthritis: a randomized, placebo-controlled cross-over study. Rheumatology, 38, 864-869.
Singh, B. B., Berman, B. M., Hadhazy, V., Bareta, J., Lao, L., Zarow, F. M., Hochberg, M. (2001). Clinical decisions in the use of acupuncture as an adjuctive therapy for osteoarthritis of the knee. Alternative Therapies in Health and Medicine, 7 (4), 58-65.
Ezzo, J., Hadhazy, V., Birch, S., Lao, L., Kaplan, G., Hochberg, M., Berman, B. (2001). Acupuncture for osteoarthritis of the knee: a systematic review. Arthritis Rheum, 44 (4), 819-825.
Bonta, I. L. (2002). Acupuncture beyond the endorphin concept? Medical Hypotheses, 58 (3), 221-224.
Andersson, S., Lundeberg, T. (1995). Acupuncture—from empiricism to science: functional background to acupuncture effects in pain and disease. Medical Hypotheses, 45 (3), 271-281.
Peng, C. H., Yang, M. M., Kok, S. H., Woo, Y. K. (1978). Endorphin release: a possible mechanism of acupuncture analgesia. Comp. Med. East. West., 6 (1), 57-60.
Sato, A., Sato, Y., Suzuki, A., Uchida, S. (1996). Reflex modulation of catecholamine secretion and adrenal sympathetic nerve activity by acupuncture-like stimulation in anesthetized rat. Japanese Journal of Physiology, 46 (5), 411-421.
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