Acupuncture in cancer pain

1.1. Scientific name

The term “acupuncture” is derived from Latin and means ‘piercing with a sharp instrument’.

1.2. Ingredients

Acupuncture is usually performed with fine needles but many variations exist. “Acupoints” might, for instance, be stimulated by electrical currents with or without needles (electro-acupuncture), by pressure (acupressure), by heat (moxibustion) or laser light (laser-acupuncture).

1.3. Application and dosage

Acupuncture is applied to the body surface. The dosage depends on the condition treated. Sometimes only one acupoint is stimulated; more commonly several needles are applied. Sometimes acupoints along meridians and sometimes trigger points unrelated to meridians are needled. Sometimes only specific areas of the body, e.g. the ear (ear-acupuncture) are treated; more commonly several areas are needled. Sometimes needles or studs are left for days or weeks; more commonly they are removed after a ~30min session. Sometimes the needles are “stimulated” by manual manipulation; at other times they are left unstimulated. Sometimes treatments are repeated regularly, e.g. twice weekly; at other times a treatment can comprise of just one single session.

1.4. History/providers

The history of acupuncture goes back to ancient China and its Taoist philosophy. In TCM, the life energy “Qi” flowing through the body in meridians and the balance of yin and yang are thought to determine human health. Illness is seen as an imbalance of these energies and acupuncture is perceived to be one method for re-balancing the imbalance. Traditionally, acupuncture was not used primarily for pain control. Yet, in recent years, pain-control seems to have become its main purpose in many clinical settings.

Acupuncture became popular outside Asia after the US president Richard Nixon visited China. Subsequently scientific investigations into this area began.

1.5. Claims of efficacy

In TCM, acupuncture is considered to be a therapy for most human illnesses. By contrast, the modern concepts of acupuncture predict that it is efficacious only for a limited range of conditions.

1.6. Mechanisms of action

The concepts of TCM acupuncture postulating energies, meridians etc are not supported by scientific evidence. Neurophysiological theories to explain acupuncture’s modes of action have been developed, e.g. gate-control mechanism, and effects on neurotransmitters like endorphins 1.

1.7. Alleged indications

According to TCM concepts, acupuncture is a therapy for most symptoms and diseases. Modern concepts are centred around the management of pain and conditions likely to be influenced through effects on neurotransmitters 1.

1.8. Prevalence of use

In many countries, acupuncture is now one of the most popular forms of CAM. Most modern pain clinics and many oncology centres across the world routinely offer acupuncture as one of several therapeutic options. Exact prevalence figures vary from country to country and from setting to setting.

1.9. Legal issues

In most countries, acupuncture is administered by both medically-trained and statutorily regulated professionals (e.g. doctors, physiotherapists, nurses, midwives) and by non-medically-trained and often unregulated acupuncturists.

1.10. Cost and expenditures

In the UK, one session lasting about ½ hour would currently cost between £40 and £80. One series of treatments would normally comprise 5-20 sessions.