Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
12 Jul

Dear Mark: Acupuncture

With all the recent focus on alternative and complementary therapies, the number of people using acupuncture and the variety of conditions it’s used for are quickly expanding in the U.S. A good number of MDA readers use it, I know, and quite a few have asked about it over the years. A few I know visit a practitioner regularly and maintain that the routine figures strongly in their ongoing good health. Some reject it outright as a medical practice, while still others look to it as a last resort for a specific (and often acute) problem. Finally, some have considered using acupuncture but remain on the fence, like reader Abe:

Dear Mark,

Going fully Primal several months ago has helped me lose all the weight I needed to, and I’m in good shape since changing my workout when I began reading your blog a year and a half ago. The problem is, I still have some chronic back pain (although it’s not as bad as it used to be). I feel like it’s the last thing holding me back. The usual stuff (chiropractic, etc.) just hasn’t done it for me. What do you think about acupuncture? I’ve heard good things but don’t know if it’s just the power of suggestion. Just thought I’d get your take. Thanks!

Over the years I’ve approached alternative treatments like acupuncture with the same healthy dose of skepticism that I bring to just about every health question, issue and ideology. I read up and usually reserve judgment as I check the research over time. Though I relish listening to folks’ personal experiences, I always come back to the larger frames of quality medical study and evolutionary logic.

Developed over thousands of years, acupuncture centers on the (pre-scientific) Traditional Chinese Medicine theory of energy (qi) and its free or stagnant travel among specified channels in the body. It was (and still is by some) thought that when energy is blocked in its movement throughout the various meridians, disease or disorder ensues. Acupuncture (and acupressure) attempt to stimulate and release these blockages to allow energy to move freely and the body to naturally correct itself. The practitioner inserts the needles in therapeutic points along relevant meridians. For added impact, he/she often twists the needles or even hooks them up to a machine that will deliver continuous electric stimulation through the needles, an adaptation that is rejected by some traditionalists but has been shown to be more effective in some research.

Although there are plenty of studies on both sides, so to speak, recent research tends to increasingly support the effectiveness of the therapy. A recent study at the University of York, actually, made significant strides in possibly explaining the physiological mechanism behind acupuncture. The researchers found evidence of acupuncture’s neural impact. The treatment induced “deqi” sensations (achieved when the practitioner allegedly inserts and manipulates the needle correctly to reach the qi) in research subjects, which scans showed deactivated pain sensors in their brains. Nonetheless, controversy does continue particularly for acupuncture’s effectiveness for certain conditions. Some research shows acupressure to be as effective as acupuncture. The most accepted conditions for acupuncture/acupressure treatment include low back pain, (there you go, Abe!), migraines, depression, anxiety, chronic pain caused by fibromyalgia and arthritis. Acupuncture is also commonly used for nausea and chronic pain associated with cancer and cancer treatment.

It’s important, of course, to find a reputable practitioner with superb training. Physicians and medical facilities that support the use of complementary medicine should be able to offer thoughtful referrals, but check out organizations like NCCAOM (National Certification Commission for Acupuncture and Oriental Medicine) for lists of licensed acupuncturists in your area. Ask plenty of questions about the practitioner’s experience and specialty, and don’t be shy about inquiring about references or affiliations with area clinics or other professional groups.

Finally, I’d recommend bringing an open mind and reasonable expectations to your treatment. (This point goes with any kind of therapy – conventional or alternative.) As mentioned, I think the overall research supports acupuncture’s genuine utility in some cases. Nonetheless, I’d venture to say that a negative mindset can sabotage a legitimate treatment as much as a hopeful outlook can boost a placebo’s effect. (Maybe that’s why my own experiences with acupuncture have been, shall we say, less than satisfying?) Although many people experience some relief from pain, for example, right away, acupuncture’s effect can take a while to settle in. In most situations, successive treatments offer compounded effect. In other words, it’s worth sticking with for at least a short while to judge the overall influence acupuncture therapy can have over your pain or specific medical condition.

Fellow Grokkers, have you used acupuncture? What say you? Share your thoughts and stories with Abe and others in the MDA group. As always, thanks for the great questions and comments, and keep ‘em coming!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. It’s not something I’d like to have done myself – I agree with the comment that the practitioner would have to be very good – but it certainly seems to be effective with some ailments. What’s more it has been used on animals, which rather indicates that it’s not a placebo effect at work.

    Interestingly, the 5300 year old “Iceman” found in the Italian/Austrian Alps in 1991 had tattoos that were over what are known acupuncture points. Maybe they were indicators to tell someone where to apply pressure when he was in pain from his ailments, or something like that.

    http://www.msnbc.msn.com/id/31965532/ns/technology_and_science-science/

    Lewis wrote on July 12th, 2010
  2. I tried about four sessions of acupuncture for long term hip pain about two years and had good results. It relieved the pain (took several sessions) and the pain has never come back.

    One of the beautiful things about it is there are virtually no side effects, which certainly isn’t true of pain medications.

    Page wrote on July 12th, 2010
  3. In addition to lack of knowledge about its uses, one of the barriers people face to receiving acupuncture is the high price. Office visits can cost $50 to $150+ for one treatment, and a series of treatments is usually necessary.

    Many acupuncturists are beginning to switch to a community-acupuncture model. In these offices, treatments are done in a group setting and the fee is lower, usually a sliding scale of around $15-40 per treatment. Any condition that can be treated by acupuncture can be treated in a community setting, and results are often better because patients can afford to come in as often as they need to.

    The non-profit Community Acupuncture Network provides a list of community acupuncture practices here:
    http://www.communityacupuncturenetwork.org/clinics

    Emily wrote on July 12th, 2010
    • Thanks for the tip, Emily. I found a group in my town and will look into it. m

      MikeL wrote on July 13th, 2010
  4. I’ve become sceptic, over the years, about anything that isn’t backed by science or a clear explanation.

    It’s nice that Mark pointed a some research explaining the practice, but it will take much more to convince me.

    Lets say that I paid the price for believing things that are not rooted in either science or my own tests and observation.

    This is why eating like grok makes sense, real, non bogus science is there to explain how our bodies process different foods.

    sebastien wrote on July 12th, 2010
    • One of my best friends from college is a Neurologist and acupuncturist. He received his MD here in the US, but also had formal training in traditional acupuncture (his father, who immigrated from China, is an acupuncturist as well). He is confident in its effectiveness, but readily admits that it likely has nothing to do with energy flows or qi. And he also admits it will only work for some people, and is not typically effective for folks who have a scientific background. Belief is essential.

      Ultimately, pain is entirely a construct of our brains. This is why so many war veterans missing limbs can continue to have pain an in an extremity they no longer possess. And pain processing in the brain is quite complex, and can be influenced by multiple factors (which is why people with identical injuries/pathology can have such varying levels of pain). And our beliefs about how painful something is, or will be, matters significantly, and is likely where acupuncture exerts its effects. Our brain, being the dynamic, plastic structure that it is, is capable of reorganizing its pain pathways – in some, acupuncture likely helps it to do so in a favorable way.

      Of course, the unfortunate catch 22 is that if you understand this to be its mechanism of action, then it won’t work for you!

      Josh wrote on July 12th, 2010
      • BELIEF IS ESSENTIAL? Thats why it works so well with animals they have such a strong belief system.

        Ned Holle wrote on July 15th, 2010
  5. My stepmother used to have horrible horrible migraines that the doctor kept giving her stronger and stronger medicine, but eventually, the pain meds didn’t help any more. (I think it would help if she would stop eating grains, but you can only do so much) She has had less pain since she has gone to acupuncture. My Dad has also had some relief of the sinus problems he’s had since forever (probably due to grains and mistreated sinus infections when younger). My grandmother also had some relief before she got knee surgery on her knee.
    I myself am an energy worker, although I don’t do acupuncture. I can feel when energy is blocked. Energy work/acupuncture should be used in conjunction with other treatments, a holistic approach, because other wise you are just treating the symptoms. Releasing the energy blockage can help the body heal, but sometimes the body needs extra help. For instance, Abe has tried chiropractics, but using chiropractics along with acupuncture, stress relief exercises, massage/yoga, and some nervine and skeletal herbs, his back would probably be in great shape in six months. People have to remember to treat illnesses/injuries holistically. Everything starts with the diet and exercise. Check! Then the mental/spiritual and then the energy. If one is out of whack, it messes up the whole system.

    Ris wrote on July 12th, 2010
  6. I would say that if one is having severe back pain and has for a while and just came seem to find anything that makes them better, then acupuncture may be a good idea.

    If I had severe back pain that was bothering me beyond belief, had enough the money, knew of a phenomenal practitioner with years of experience, and was not afraid of needles then I would go ahead and give it a shot.

    But, if any of these factors were a negative, then I would continue to look for alternatives and continue to be more active, sit way less, walk way more, do back exercises, not think about it, etc.

    Just my 2 cents – I hope it helps someone!

    Primal Toad wrote on July 12th, 2010
  7. I am biased, but my opinion is that going to a chiropractor or getting acupuncture may very well relieve your symptoms, as Ris wrote. Sometimes treating symptoms may help you get to the cause and correct it sooner. However, back pain is usually caused by a habitual way of standing or moving (or perhaps not moving enough). I would try a few sessions with a therapeutic pilates teacher, or just reading and educating yourself about how to acheive optimal muscle recruitment habits in standing, sitting, and moving. It seems that many times treating back pain has to begin with some very subtle, mindful exercises, which can be hard for a strong person to feel satisfied with….but worth the effort.

    Jessi wrote on July 12th, 2010
  8. A friend of mine was bitten by a few hobo spiders and had some issues with necrosis of the skin. Nothing the MD’s did helped him. Got to the point where he was seriously considering amputation of the arm at the elbow and leg at the hip.
    A friend suggested he get acupuncture first from a lady she knew. Within a week of said treatment the necrosis effect was gone and pain was receding.
    Within a month he had new skin and muscle and seemed none the worse for wear.

    Brett wrote on July 12th, 2010
    • I am a big fan of the Primal lifestyle and I recommend it daily in my practice. I am also a big fan of acupuncture. I often mix that specialty with my treatments by referring to acupuncturists I work with. I am a chiropractor who specialized in women issues. I am against those chiropractors who spend the typical 5 – 10 minutes and always do the “same three adjustments”. I usually need 30 minutes to fix someone. Abe if you have ever fell on your butt (even if it’s been years ago) please have someone (very competent) assess your tailbone. I’ve seen so many relief in my practice on women who had hip pain, low back pain, sacro-iliac joint pain from fixing that bone that I might start a study in the next year on it. You want a practitioner that can also check the alignment of your feet (there’s more than 20 bones in each foot!), knee hips and jaw as the typical chiropractor only check the spine. You want someone that assess your whole body which acupuncture will do, an osteopath (trained in Europe, not an osteopathic physician) will do, a rolfer will do too and an applied kinesiologist-chiropractor will do too. Just though I would give you some help with what I have seen work in my practice. Good luck!

      Marie wrote on July 12th, 2010
  9. The idea that acupuncture is based on mysterious energy flowing through imaginary meridians is false. It resulted from gross mistranslations of classic Chinese medical texts by a French bank clerk named Georges Soulie de Morant.

    Soulie de Morant lived in China in the early 20th century, and became enamored with Chinese culture – including medicine. He tried to translate ancient Chinese medical texts, despite having no training in medicine, anatomy or the ancient Chinese dialect the texts are written in (which even modern Chinese people can’t understand).

    Unfortunately, all of the books we study on Chinese medicine in the West are based on Soulie de Morant’s mistranslations. This idea of qi being “energy” and meridians being invisible lines is a uniquely Western creation and doesn’t correspond to traditional Chinese theories.

    If you look at what those ancient medical texts actually say, it becomes clear that Chinese medicine is a “flesh & bones” medicine based on the same anatomy and physiology as Western medicine. In fact, the Chinese discovered continuous blood circulation almost 2,000 years before it was discovered in the west. They were performing detailed dissections, in which they measured and weighed the internal organs and blood vessels, 500 years before the birth of Christ.

    Modern research continues to shed light on the physiological mechanisms of acupuncture. It promotes blood flow, reduces pain, reduces inflammation and restores homeostasis. It does this primarily by stimulating the peripheral nervous system.

    Unlike drugs and surgery, acupuncture addresses the underlying cause of disease and dysfunction by activating the body’s self-healing mechanisms. And since the body has far more expertise on healing than even the most brilliant physician, this is the wisest approach to regaining health.

    It’s a shame that acupuncture is so misunderstood in the West, even by the people who practice it. It’s a potent treatment with almost no side effects that has a 3,000 year history of successfully treating most common health conditions.

    I’ve written a series of articles explaining all of this in more detail on my blog. You can read it here:

    http://thehealthyskeptic.org/acupuncture

    Chris Kresser wrote on July 12th, 2010
  10. Hmm, first time poster here as new to primal and loving it. However, I like primal precisely because Mark has done a great job of cutting through the nonsense to the science and I can’t agree that the science is at all coming down on the side of accupunture. I think the evidence is actually pretty overwhelming that any effect is is a placebo response, and a recent decision to authorise it’s use on the NHS here in the UK effectively admitted it was only beacuse it was no less ineffective as most other treatments also are (mainstream physiotherapy etc also have very poor success rates for back pain). That’s not to say it doesn’t do something, as the placebo effect is a very powerful tool, unfortunately using tricks to generate it is a pretty unsatisfactory way to manage your health, especially when things like hypnotherapy can induce similar responses without the deception of a fake practice. The truly excellent doctor and science journalist Ben Goldacre reviews the evidence for accupunture here:

    http://www.badscience.net/2007/09/acupuncture-and-back-pain-some-interesting-background-references/

    Steve wrote on July 12th, 2010
  11. Sorry, but I couldn’t resist showing this great paleo-esque cartoon:

    http://tenerife-training.net/Tenerife-News-Cycling-Blog/wp-content/uploads/2007/11/mammoth-acupuncture-cartoon.gif

    cheers

    pieter d wrote on July 12th, 2010
    • That’s funny! Very apropos.

      Maxine wrote on July 15th, 2010
  12. I have intermittent low back pain and one problem I have found with acupuncture is the fact that it doesn’t typically provide immediate relief when I throw my back out. I’m not saying that acupuncture isn’t an effective therapy; I am just saying that it doesn’t provide immediate relief for an acute injury like pain meds do.

    It’s like stretching. Stretching is an effective way to prevent injury, and only then if you stretch regularly. But if you blow out your hamstring, stretching isn’t going to provide any immediate results since it’s already too late for that.

    So it goes with acupuncture: it is probably an effective therapy to help prevent future injury, and it is probably an effective therapy if used continually to help treat a previous injury, but it isn’t a silver bullet to provide immediate relief for a current injury.

    CJ wrote on July 12th, 2010
  13. I decided to try acupuncture to deal with a couple of symptoms, and what the practitioner told me corroborated with what a blood test later indicated. My symptoms have not gone away entirely, but I do believe that it has helped somewhat.

    I don’t see it as a replacement for traditional medicine, but rather as a complement to it; to fill in those gaps which traditional medicine does not fill.

    Invest It Wisely wrote on July 12th, 2010
  14. Also, a note about placebo. Modern research suggests that placebo accounts for between 30-70% of the therapeutic effects of any treatment – drugs and surgery included. In the case of some medications, like antidepressants, that number is closer to 80%.

    So, while it’s true that placebo is a significant part of the therapeutic response to acupuncture, it’s an equally significant part of the therapeutic response to drugs and surgery. Most doctors either don’t understand this or won’t admit it. They’d like to believe they type of medicine they practice is somehow more objective or impersonal than traditional forms of medicine. But in reality, conventional western medicine is just as influenced by cultural and psychosocial factors.

    I’m always baffled when people denigrate placebo as if it’s something we should eliminate from medicine if we could. How ridiculous. Placebo is nothing less than the body’s ability to heal itself. In fact, placebo researchers have suggested renaming placebo to “contextual healing” or “the meaning response” to more accurately describe the phenomenon.

    We know now that the so-called “placebo effect” involves real physiological changes in the body often indistinguishable from the changes induced by drugs, surgery or other interventions. The healing effects are no less genuine in placebo than with other treatments. Placebo is free, and has no side effects.

    I think the most skilled practitioners are those that can stimulate and harness the power of placebo in their treatments. The old-school physicians knew this. The paid a lot of attention to bedside manner and how they communicated with patients, because they knew those intangibles had a huge effect on treatment outcomes.

    These days, when you go to the doctor he or she is staring at a laptop the entire time and not even looking at you. There’s hardly any time for a connection to be made. If you understand placebo and its role in medicine, it’s clear why people are so dissatisfied with the the current system and why it is so ineffective.

    Chris Kresser wrote on July 12th, 2010
    • Hi Chris, it’s a great point you make and I completely agree, the placebo effect is probably the great underused and misunderstood ways humans have of managing their health. Unfortunately though most treatments which are effective due to placebo response are often either misleading or deliberately fraudulent by claiming an effect caused by nonsensical concepts which disguises the placebo response reality. More importantly though, if treatments focused on the placebo itself rather than all the nonsense around so many treatments then true expertise on what is really effective at generating the incredible health benefits placebo can bring could be much more fruitfully investigated. Treatments like hypnotherapy for example explicitly use the placebo response. They effectively state “your psychological response to this illness/situation can affect your physcial outcomes, here’s how you could alter your response to help”. That is an honest approach to trying to utilise the benefits of this extraordinary factor of mind/body interaction that is far more beneficial than kidding people on they are getting better because of silly ideas and magic as so many therapies do. The science writer I mentioned earlier, Ben Goldacre, is one of the fiercest critics of evidence free treatments and one of the most passionate exponents of the importance of the placebo effect.

      Steve wrote on July 12th, 2010
    • Well, Chris, chalk me up as a nay-sayer, at least a little bit.

      I will violently agree that the body has a tremendous ability to heal itself, and that the mind has a tremendous, perhaps even overriding influence on the body.

      But the point of testing *a drug* is to see what *the drug* does, not to see what *people* do because they *believe* the drug will work. In that context, the placebo affect is a harmful distraction.

      In the context of a physician treating a real live human being, then they should by all means harness all the tools at their command, “contextual healing” included. Just so long as they’re aware that they’re doing it, and do it correctly.

      What I mean is, the placebo affect is harmful if it misleads a physician into thinking that *a treatment* had some beneficial affect on a patient, when in fact it was essentially the patient being convinced they’d get better, and so they do, irrespective of the treatment. That’s fine for that patient, but what about all the other patients that doctor has?

      Larry Clapp wrote on July 12th, 2010
      • Thank you Larry, you put that far more eloquently than my attempt above!

        Steve wrote on July 12th, 2010
    • Yes, to sum up I would say conventional/western medicine (however you want to describe it) has lost sight of the ‘art’ of healing in favour of the ‘science’.

      A former GP I know became a physchotherapy practioner who then developed his own ‘system’ for this very reason believing that disease was just that – dis-ease, ie the bodies final response to ignoring other stresses, usually emotional/stress-related. Thess ‘blockages’ finally manifest in physical disease. If you can process those ‘faulty’ thought processes you can reverse/prevent a wide range of physical ailments.

      Slightly off topic but it’s all down to allowing the body to do what it has always been able to!

      Kelda wrote on July 13th, 2010
    • Chris, well put. I’ve also long wondered this myself, perhaps because I’ve had good (as well as bad) experiences with acupuncture, mostly during y 13 years in Japan. “I’m always baffled when people denigrate placebo as if it’s something we should eliminate from medicine if we could. How ridiculous. Placebo is nothing less than the body’s ability to heal itself. In fact, placebo researchers have suggested renaming placebo to “contextual healing” or “the meaning response” to more accurately describe the phenomenon.”

      We should be all over the placebo effect. Give me more of that!

      Jeanmarie wrote on July 17th, 2010
  15. I am an Acupuncturist from Portugal and because of the hype Acupuncture is having in the world I would not be treated by some therapist that says he/she is an Acupuncturist. I would try to know where the the therapist studied, the background and the approach that it is used in treatment. I am a little bit of a traditionalist so, I think that’s the way. But most importantly I think a good therapist as to go the Chinese Medicine way and not using Acupuncture as a sole therapy, that’s why I am into the Primal way of life and that’s why I try to change the eating habbits of my patients and I’ve had really good results with this approach.

    Thank you Mark and sorry for my bad english.

    Mingmen wrote on July 12th, 2010
  16. I have had incredible results with acupuncture in the past, going from weekly exhaustion to full on energy with one treatment. I was considering myself an acupuncture junkie.

    However, when I moved to Kauai I did not find any such results from several acupuncturists until now when I am going to a terrific gal who also includes other modes of therapy.

    I became interested in this when my dog responded miraculously to the treatments. This convinced me that it was not a mind thing.

    I agree. Go with an open mind and if you do not get results from the first one or two — try another.

    Aloha,
    Ellie

    Eleanor Snyder wrote on July 12th, 2010
  17. For the past 9 months, I’ve undergone weekly acupuncture treatments for my feet/ankles. I suffer from arthritis, a result of being hit by a car while riding my bike 8 years ago.

    The results have been mixed: I experienced temporary relief that would last 24-48 hours. I’m presently taking a break from acupuncture as the cost over 9 months got quite high – my insurance doesn’t cover it. (Note: I’m very active, including doing CrossFit, which may be why I don’t get more pain relief)

    IreScotsWelsh wrote on July 12th, 2010
  18. My new chiropractor really helped my shoulder and neck pain with the use of acupuncture. I have also started having therapeutic massage in place of traditional chiropractic treatments with great results. So good, in fact, that I will probably not go back to normal chiropractic treatments and plan to stick with the massage. In my case, they are both about the same price (no insurance coverage) and the massage last a LOT longer with better results.

    Cassandra wrote on July 12th, 2010
  19. I had this done years ago when the balls of my feet ached so bad I was in pain when ever standing or sitting, one application and I was feeling great and the problem never reoccured. I did get a recommendation on the Dr. though which I guess is the wise thing.

    Brian wrote on July 12th, 2010
  20. awesome article. i’ve wondered if there was any science behind the effectiveness of accupuncture

    Sam wrote on July 12th, 2010
  21. I have gone to an acupuncturist of and on since the 70’s and found it and the herbs prescribed by the practitioners very helpful while going through menopause. My daughter used to get high fevers due to ear infections and I took her to my practitioner for the fever after being unsuccessful at getting it to come down the usual methods. I know my daughter did not like having needles stuck in her arm (and you can be sure she was not a “believer”) but the fever came down within a couple of minutes.
    Due to treatments I was able to weather menopause without hormone replacement therapy. This is a whole long story that I will not get into here but I am grateful that this treatment method was available when I needed it.

    Classic wrote on July 12th, 2010
  22. The idea that acupuncture is based on mysterious energy flowing through imaginary meridians is false. It resulted from gross mistranslations of classic Chinese medical texts by a French bank clerk named Georges Soulie de Morant.

    Soulie de Morant lived in China in the early 20th century, and became enamored with Chinese culture – including medicine. He tried to translate ancient Chinese medical texts, despite having no training in medicine, anatomy or the ancient Chinese dialect the texts are written in (which even modern Chinese people can’t understand).

    Unfortunately, all of the books we study on Chinese medicine in the West are based on Soulie de Morant’s mistranslations. This idea of qi being “energy” and meridians being invisible lines is a uniquely Western creation and doesn’t correspond to traditional Chinese theories.

    If you look at what those ancient medical texts actually say, it becomes clear that Chinese medicine is a “flesh & bones” medicine based on the same anatomy and physiology as Western medicine. In fact, the Chinese discovered continuous blood circulation almost 2,000 years before it was discovered in the west. They were performing detailed dissections, in which they measured and weighed the internal organs and blood vessels, 500 years before the birth of Christ.

    Modern research continues to shed light on the physiological mechanisms of acupuncture. It promotes blood flow, reduces pain, reduces inflammation and restores homeostasis. It does this primarily by stimulating the peripheral nervous system.

    Unlike drugs and surgery, acupuncture addresses the underlying cause of disease and dysfunction by activating the body’s self-healing mechanisms. And since the body has far more expertise on healing than even the most brilliant physician, this is the wisest approach to regaining health.

    It’s a shame that acupuncture is so misunderstood in the West, even by the people who practice it. It’s a potent treatment with almost no side effects that has a 3,000 year history of successfully treating most common health conditions.

    I’ve written a series of articles explaining all of this in more detail on my blog. I’m having trouble posting a link, but you can find it by googling “the healthy skeptic acupuncture”.

    Chris Kresser wrote on July 12th, 2010
  23. Larry, I agree that placebo can have a confounding effect on research studies and that this makes it difficult to determine the efficacy of a drug.

    Part of the problem, though, is that clinical trials are based on a mechanistic, reductionist view of the body. They don’t take factors like the patient-practitioner relationship, the attitude of the patient, the patient’s belief (or lack thereof) in the treatment, or the practitioner’s attitudes and beliefs into account – in spite of the fact that all of these variables have repeatedly been shown to have a significant effect on treatment outcomes.

    One of my favorite examples of this is a trial run in a hospital setting with patients that had just undergone knee surgery. They divided the patients into two groups. With one group, the surgeon came spent a lot of time with the patients both before and after surgery, connecting with them, listening to their concerns, explaining the procedure and expressing optimism that it would work. With the other group, the surgeon came in and out of the room quickly, didn’t explain anything, and treated patients brusquely. All patients received the surgery and the same drugs during recovery.

    Guess what? The average recovery time in the first group was 3-5x faster than in the second group.

    My point is simply that we should be studying the mechanisms of “placebo” (or “contextual healing”, as I prefer to call it) and doing everything we can to integrate it into the clinical encounter.

    Chris Kresser wrote on July 12th, 2010
    • > My point is that we should be studying the mechanisms of contextual healing and doing everything we can to integrate it into the clinical encounter.

      I agree. But that’s really hard. You can’t prescribe attitude, or belief. You can tell doctors that interacting with their patients is associated with them healing faster / better, in the same way that you can recommend physical therapy to a knee-surgery recipient, but making either group follow your recommendation is hard.

      Of course just being hard is no reason not to advocate for it.

      Speaking of PT, did your favorite example control for that? That is, did it account for the possibility that the interaction with the surgeon made the patients more likely to follow through with regular and enthusiastic PT?

      If interacting with a personable and upbeat doctor *in and of itself* decreased recovery time, that’s important news. If it “merely” made people attend PT more often or pursue it more enthusiastically, and *that* decreased their recovery time, then that’s a different result. It’s still important, because getting people to go to PT can be like pulling teeth. :)

      Larry Clapp wrote on July 13th, 2010
      • I agree that you can’t make a doctor spend more time with his patients and have a good bedside manner. But as a patient, you can know that the relationship with your doctor/surgeon makes a huge difference in your healing and take charge of that.

        If more people fired their docs and found ones that were better partners in health care, maybe one or two would change their ways.. or not. Either way, having that knowledge makes one a better advocate for their own health care.

        Those that don’t want to make the effort, well… that’s their own choice. And they get what they put into it…

        Minxxa wrote on July 13th, 2010
        • Some practices are now allowing only 7 minutes per patient! Hardly time to even find out what is going on with the patient.

          Debrah wrote on July 14th, 2010
  24. This is not about acupuncture for chronic back pain- rather just a thought wondering if the person posting has definitely eliminated dairy from their diet. I find if I use any dairy at all my back feels it immediately. May be a consideration.

    Mary Ellen Brunsdon wrote on July 12th, 2010
  25. Primal folks (by definition of the word, and the high esteem placed on Grok) seem to favor that which has been proven by the test of time, yes?

    Try this: the first medical school in the West was founded in the 1100’s, A.D. But Chinese medicine and acupuncture have been practiced for the past 4000 years.

    No way it’s going to stand the test of time unless there’s something to it, eh?

    Adam Kayce wrote on July 12th, 2010
  26. Chris Kresser wrote a very interesting and informed series of blog posts on this subject starting here:
    http://thehealthyskeptic.org/chinese-medicine-demystified-part-i-a-case-of-mistaken-identity . Seems like he is too nice to link to his own stuff, but I am one of those rude types so I am going to do it anyway! ;-P (hopefully, there is no rule against it.)

    Eva wrote on July 12th, 2010
  27. I worked for an acupuncturist in college. I did graphics in exchange for regular treatments. Those treatments sent me down a long track that led me to a healthy present state.

    Acupuncture works. Not sure how or why, though I’m sure the scientists will eventually make sense of it all…

    Thanks for giving Oriental Medicine some air time!

    Shauna wrote on July 12th, 2010
  28. I did acupuncture for years and it cured many of my problems. This was all before i went primal. since going primal, I no longer “need” acupuncture as much as i used to and because of the recession (and insurance refusal to pay for) I have forgone my treatments.

    I will say this about acupuncture, I ran a marathon with 8 of my friends. I am not a runner. this was a huge challenge for me. The morning after I went and got acupuncture. The following day I took an intense spin class at the gym, and my fellow runners slept on our sorority’s couch down stairs because they were too sore to make it up the stairs.

    Mar wrote on July 12th, 2010
  29. Have had it. Have friends who’ve studied and practice it. It has a long and deep tradition. WHO endorses it for some conditions. All that together gives it lots of credibility with me. That said, there are undoubtedly conditions for which acupuncture alone is insufficient. Most US TCM practitioners use a traditional Chinese pharmacopeia, and make referrals for Western treatments.

    slacker wrote on July 12th, 2010
  30. I personally wouldn’t use acupuncture because I feel a little funny about people twisting needles in my skin, so I don’t think this particular treatment would have any benefit for me. That said alternative therapies are usually free from side effects so where’s the harm in trying out the power of belief instead of reaching for those poisonious pills.

    Laropmet wrote on July 13th, 2010
  31. I came to put one more log in the fire: can you induce the placebo effect in animals??? I think not… So if accupuncture only functions with the placebo effect how does it work with animals?

    Mingmen wrote on July 13th, 2010
  32. The placebo effect is fascinating, and remarkably powerful. My graduate degree is in medical sociology, and I came in as a skeptic and left with a great deal of respect for it.

    Wired ran a pretty good article for those interested in more detail:

    http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect?currentPage=all

    BPM wrote on July 13th, 2010
  33. Several review articles have established that acupuncture is distinguishable from placebo. This is one: http://www.jclinepi.com/article/S0895-4356(08)00063-2/abstract.

    However, as the above article points out, it’s less clear whether traditional theories of point selection have any bearing on treatment outcomes.

    I have seen a difference in my experience as a practitioner, but the research doesn’t support it at this point.

    Chris Kresser wrote on July 13th, 2010
  34. Great point above — I was just thinking of posting that while I haven’t had acupuncture myself, my dog has after a neck strain (and it did seem to help, although we did a number of things at once so I can’t really say), and I know a lot of people in the greyhound community who have had excellent results with it for spinal or neuromuscular issues with their dogs.

    Anne Myles wrote on July 13th, 2010
  35. Larry,

    Physical therapy wasn’t involved in that study.

    There are many others with similar results. Whenever I try to post a link, my comment goes into moderation and never appears. But try Googling “deconstructing placebo effect meaning response” and that will bring up a great study by Moreman, who also has a fantastic book on placebo.

    Chris Kresser wrote on July 13th, 2010
    • Thanks, Chris!

      Larry Clapp wrote on July 13th, 2010
  36. The original question was about acupuncture for back pain. Often a lot of the pain is caused by muscle spasm, and acupuncture can bring quick relief by ending the spasm.

    But in most cases, the back went into spasm because of the person’s posture and/or body mechanics. The long-term solution to back pain is to learn to stand, sit, and move the way Grok did. Esther Gokhale’s book “8 Steps to a Pain-Free Back” explains how to do that. Esther’s work was described several months ago here on Mark’s Daily Apple:

    ttp://www.marksdailyapple.com/primalcon-2010-announcement-sit-stand-and-walk-like-grok/

    Bahv wrote on July 13th, 2010
  37. Dr. John Sarno M.D. of NYU has a theory that has born itself out over his 40 years of practice: That most chronic back pain is actually initiated by something very akin to the fight-or-fight response, and that it’s a mind/body process that can be reversed simply by learning how the process works. People (myself included) have actually cured their pain just by reading the information in his books. The best one is “Healing Back Pain”. It’s at most bookstores and has been in print since 1986.

    NOTE: he’s NOT saying: “the pain is in your head”.

    Joe wrote on July 13th, 2010
  38. Esther Gokhale wrote an incredible book on back pain, 8 Steps to a Pain-Free Back, that very much fits with the Primal lifestyle. It’s based on the premise that we no longer learn proper alignment from our “tribe.” The simple changes she recommends changed my life.

    That being said, acupuncture has been very helpful for other ailments.

    Kelly wrote on July 14th, 2010
  39. Tell Abe that what he needs is to find a clinic or gym that has a MedX Lumbar Extension machine. I’m very serious about this. I’ve been suffering from sometimes debilitating chronic lower back pain for I think 5 or 6 years now, and I’ve just started using one of these machines at the training place I go to and am already noticing improvement. I can summarize the history of the machine and the reason why it works:

    Exercise pioneer Arthur Jones (founder of the approach to exercise science known as High-Intensity Training as well as the two companies Nautilus and MedX) invented the MedX Lumbar Extension machine in the 1980s. His theory was that lower back pain is caused by chronic under-use of erector spinae muscles in the lumbar region, and that it could be cured by strengthening these muscles. What he found, however, is that the ONLY way to meaningfully strengthening these muscles is to isolate them by completely constraining the hips from rotating. Most exercises that people do that they THINK work their lower back actually don’t work at it all, because the hip extensors kick in and do the work instead. The protocol for the machine only requires 1 set down to failure (takes about 2-5 minutes) once per week.

    This protocol on the MedX Lumbar Extension machine has been scientifically proven to CURE chronic lower back pain in 80% of patients. The other 20% are people who actually have spinal pathologies of some sort that require surgery. For that 80%, this machine is literally the only way to cure chronic lower back pain by attacking the problem’s actual root cause. Things like acupuncture, or tylenol, or massage therapy, or icy-hot, don’t actually CURE the problem, they simply provide a temporary REMEDY for the symptoms.

    Mark, I really enjoy reading your blog and I plan on buying your book as soon as I’m done reading “Good Calories, Bad Calories,” but if you are going to discuss chronic lower back pain then you MUST do some research on the MedX Lumbar Extension machine.

    Arthur Jones’ original writings on the topic can be found at http://www.arthurjonesexercise.com, I think the ones on the lower back are mostly under “The Future of Exercise.” Also, the MedX company website (Jones doesn’t own it anymore, he died in August 2008) is http://www.medxonline.com.

    Mark, if you did some research on this topic, it would be a great thing for you to do a post on!

    Luke wrote on July 14th, 2010
  40. I started getting Acup. over 12 yrs ago after I graduated from massage school. We learned about the meridians in Shiatsu class, which was part of my schooling. I was amazed at the information and how well one can know the body, by learning this stuff. So I decided the get Acupuncture when I graduated and the changes that took place in my life were amazing. I’ve gone to a total of 4 different Acupunct-urists all together. I’m getting treated for hot flashes this time around. I’ve had 4 treatments and I’ve noticed a difference already. He says I’ll need 6. So I will see. But I love, love, love Acupuncture. When I first met this Acupuncturist he was diagnosing me looking at my ears. Can you believe it? He was right on.. Spleen and Kidney deficiency. And he diagnosed my daughter. It was too funny. The knowledge they can aquire about the body is phenominal by looking at the ear, tongue and pulses. They know more about the body than ANY doctor I’ve ever gone to. They are my healthcare practitioner along with my nutritionist. Thanks, Nancy

    Nancy wrote on July 14th, 2010

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