Acupuncture - Isn’t it all placebo?
Acupuncture is a therapy that originated in China over many hundreds of years and is part of a system of medicine called Traditional Chinese Medicine— which was the only form of medicine in many parts of Asia until very recent history. Traditional Chinese medicine not only included acupuncture, but also herbal medicine, massage, exercise, meditation practices, lifestyle medicine, and preventive measures called yang sheng, literally “the cultivation of health” practices. Lifestyle medicine and preventive medicine uses many aspects of life to influence health including food, exercise, sleep, emotional regulation, sexual practices, pregnancy & postpartum care, exposure to nature, music, and dance, and advice when getting older.
So you could say that TCM includes
Acupuncture
Herbal medicine
Manual therapies
Dietary therapy
Mind/body therapies
Lifestyle medicine
Preventive medicine, “yang sheng”
TCM originated in China, but has been practiced in different parts of Asia, where different climates and diseases pushed the evolution of the medicine in different directions— which is why you’ll find different styles of acupuncture around today– like Japanese & Korean acupuncture. To include these styles of medicine, the term Traditional East Asian Medicine (TEAM) is often used.
What is acupuncture, and how on earth does it work?
Acupuncture is a sophisticated medicine, where different combinations of very fine needles are inserted into the body to address disease and discomfort. An acupuncturist makes an individualised diagnosis— one that not only identifies the condition, but also the root of the problem, and addresses both with a unique combination of points that counter that problem at that time. This is why the combination of points used, as well as other interventions, will vary from person to person, and with each person over time.
The scientific explanation of how acupuncture works is complex. It has been found to have effects on different types of nerve fibres, on the central nervous system, it changes the behaviour of immune cells, modulates inflammation and pain, increases circulation, influences hormonal status, and seems to exert some of its effects through the connective tissue– which may hold the key to understanding why a point on below the knee is famously used for certain digestive issues. Now, while all this is very interesting, when speaking to a patient about how their condition arose and what they can do about it, the metaphorical language of traditional Chinese medicine can simplify things, and help things make sense.
The traditional explanation of traditional Chinese medicine borrows from the language of nature, the dynamic interplay of natural phenomena, and its cycles. For example, “Dryness” of the muscles that underlie the GB channel may lead to sciatica for example, but so may “Stagnation” or “Qi deficiency”. These 3 different root causes will lead to 3 different treatments and 3 different sets of advice to counter the pattern underlying the sciatic pain. The first will give advice and use points to bring nourishment to the area, the second will aim to unlock tight muscles and promote circulation to the area, and the third will aim to tone the muscles and optimise digestive function (think about how muscle tone reduces with chronically high blood sugar levels to try to make sense of this one).
So both scientific and traditional explanations are important, and have their place in different contexts. And it’s important not to lose the traditional explanations, because although they sound a bit foreign, they hold the key to understanding why different lifestyle measures are prescribed to counter a condition, and to prevent it from arising again.
What does acupuncture help with?
It is important to remember that acupuncture is part of a system of medicine that can treat many things. Some of the most studied conditions for which acupuncture may help with include:
Pain, including
Acute and chronic low back pain
Back and pelvic pain in pregnancy
Sciatica
Restless leg syndrome
Neck & shoulder pain
Temporomandibular (TMJ) pain
Headache
Plantar fascia pain
Osteoarthritis pain
Post-stroke spasticity & pain
Cancer pain
Joint pain due to treatment with aromatase-inhibitors
Postoperative pain
Migraines, and the prevention of migraines
Irritable Bowel Syndrome
Nausea and vomiting, including
Pregnancy-induced nausea and vomiting
Post-operative nausea and vomiting
Chemotherapy-induced nausea & vomiting (in addition to prescribed anti-emetics)
Anxiety
Depression
Insomnia
Acupuncture and TCM can be used alongside conventional medicine and allied health services making a valuable contribution to integrative medicine & healthcare.
But isn’t it all placebo?
Uh…, no!! There are research studies that show that the effect of acupuncture is significantly larger than that of placebo, which is a hard thing to do, as the “placebo” interventions that have been used in many studies are not inert, as was once thought. Not having an inert placebo makes it more difficult to detect differences between people receiving acupuncture and placebo interventions in clinical studies. This is a problem with other research for which a suitable placebo is impossible - like clinical surgical and psychological studies. More recently, there has been a move away from placebo-controlled studies to studies that represent how medicine is practiced in the real world, like pragmatic studies. More studies are now comparing acupuncture to the usual medical care that you would get for a particular condition, to acupuncture plus usual care, and to people not receiving care at all (these are usually patients on a waitlist for care).
And if all this scientific discourse doesn’t interest you as much it does us, just know that many vets, including domestic vets, those in zoos, and for horse-racing use acupuncture on their animals to great effect. Just look up the videos! And placebo is not something that is possible in animals.
What are the side effects of acupuncture?
Acupuncture has very few side effects when administered by a qualified professional. Side effects are relatively minor and include pain on insertion, bleeding, bruising, light-headedness and fainting.
Is acupuncture safe in pregnancy?
Acupuncture is safe in pregnancy when administered by a qualified acupuncturist. Studies show that there are no increases in negative outcomes in pregnancy, labour or postpartum, for the baby or their birthing parent. Acupuncturists can undergo additional training and mentorship to qualify as members to the Obstetric Acupuncture Association, of which our acupuncturist, Chrisitne Guirguis, is a member. You can find an OBAA acupuncturist in your area here.
How do I know that an acupuncturist is qualified?
Acupuncturists are health professionals that need to be registered with the federal health practitioner regulation authority, AHPRA. To be registered with AHPRA acupuncturists must attain a 4-year Bachelor degree in Acupuncture which covers both biomedical sciences and traditional Chinese medicine, and fulfil continuing education requirements annually. And although acupuncturists need to be registered with AHPRA, some people who are not registered acupuncturists, yet still offer acupuncture, so it’s important to check whether they are registered with AHPRA. You can do so here.
Is acupuncture covered by medicare or private insurance?
While acupuncture is rebatable on most private health insurance plans with extras cover, unfortunately it is not usually covered by medicare. This is despite evidence of acupuncture’s usefulness and cost-effectiveness for certain conditions, it’s demand by the public to address their medical conditions, and the uptake of acupuncture in other countries under their national medicare schemes, hospitals and health systems. If you would like to see acupuncture covered by Australia’s medicare scheme, you can sign this petition to Hon Mark Butler MP - the Minister for Health and Aged Care here.
