Is acupuncture a reasonably effective intervention for the treatment of pain? Advocates will tell you “Yes” and show you dozens of studies to support their enthusiastic claim. Detractors will tell you “No” and quickly add that based on randomized control trials and recent meta-analyses acupuncture is no better than placebo to treat pain. As a third answer, the 29 faculty members, and the more than 1,300 health professionals who have graduated from the McMaster University Contemporary Medical Acupuncture Program since 1999, will tell you simply that that has been the wrong question to ask. Why? Because pain is a complex individual experience impossible to evaluate accurately, and the common way of measuring the perception of pain in clinical trials (the Visual Analog Scale) has shown a very poor correlation with the potentially devastating loss of function and quality of life that pain sufferers experience every day. This alone makes most studies of no clinical value, regardless of their conclusions and methodological quality.
Looking for another approach, in the last few years several studies performed in England have evaluated the cost/benefit of acupuncture for the treatment of pain compared to conventional treatments for the same conditions. The conclusions were favorable to acupuncture. However, when confronted with these new positive results, the usual theoreticians of the evidence-based movement still maintained that it is “scientifically unclear” whether acupuncture can be considered an effective therapy for the treatment of pain.
How does this all affect the millions of pain patients worldwide that apparently benefit from acupuncture every day? Actually, it does not. Why? Because acupuncture seems to work for them, and they could not care less how acupuncture really works, as long as it keeps working for them, and they plan to continue using it, as they will tell you if you ask them as we did.
What is the position of the McMaster University Contemporary Medical Acupuncture Program on this debate? It is summarized as the title of this article Acupuncture for pain? No thanks. Does this mean literally not to use acupuncture for the treatment of pain? Hardly, as health care professionals trained through this program are among the most successful using acupuncture to treat people with pain problems. The answer? Neurofunctional acupuncture, an innovative clinical approach pioneered and systematized by the program.
A neurofunctional approach does not seek a single hypothetical source of pain; it investigates clinically the most common levels of dysfunction associated with complex pain problems, such as neurological, biomechanical, muscular, metabolic, and psychoemotional. Understanding and evaluation of these aspects allows the design of multidimensional treatment plans. Neurofunctional acupuncture interventions are used to facilitate modulation of neurological activity at multiple levels: autonomic (vascular, visceral and central), segmental somatic (propioceptive-motor, nociceptive), and supraspinal (autonomic, somatic, limbic system, cerebellum, etc.).
Neurofunctional acupuncture treatments are designed using a fully systematized practical modular approach (with local inputs, axial and trunk inputs, and systemic regulatory inputs). Clinical outcome measures used include multiple functional indicators.
Therefore, a neurofunctional acupuncture approach is fundamentally different from the “balancing the body’s energy” used by traditional acupuncturists and from the also oversimplistic evaluation of the central perception of pain tested in the randomized controlled trials of acupuncture in the last decade.
Neurofunctional acupuncture interventions do not aim at eliminating pain directly. The goal is to promote self-regulation of nervous system activity, facilitating up- and down-regulation processes such as the production and repair of myelin sheaths, the synthesis of protein-based nerve membrane ion channels, or the secretion and metabolism of neuropeptides.
Over the last forty years, hundreds of basic science studies in laboratories (using human and animal models) have shown the effects of acupuncture on many neurological, cellular, and metabolic processes. However, to date, no scientific neurofunctional acupuncture approach has been systematically tested other than in clinical practice by the faculty and graduates of the McMaster University Contemporary Medical Acupuncture Program.
In the future, only the use of such a scientific model, fully reproducible and based on a neurofunctional rational, will be able to reliably test the ability of acupuncture to influence the functions of the nervous system and answer whether this ability is clinically useful. Meanwhile patients still need to alleviate their pain and suffering. Should we continue to use acupuncture? Ask them. We did, and the answer was clear. Neurofunctional acupuncture for pain? Yes, thank you.
For more information about the McMaster University Contemporary Medical Acupuncture Program visit McMasterMedicalAcupuncture.com/ or call Valerie Cannon at 905-521-2100 x75175
Dr. Alejandro Elorriaga Claraco, MD (Spain) Director McMaster University Contemporary Medical Acupuncture Program.
Published in Hospital News March 2011.