Getting to the Point of Acupuncture

Acupuncture is a healing art that has existed in China for over 2,000 years. It spread around the globe and its use has been on the rise in the United States over the last several decades.

In acupuncture, thin metal needles are inserted into selected points on the skin. Practitioners claim there are some 2,000 acupuncture points on the body related to pathways called meridians that carry energy throughout the body. Qi (pronounced "chee") is the Chinese word for this vital energy, which acupuncture attempts to manipulate to achieve a therapeutic effect.

A variant of acupuncture, called acupressure or shiatsu, is more akin to massage and calls for manual manipulation — pressing with the fingers — of the acupuncture points without the use of needles.

Point 1: Be Skeptical of Outrageous Claims

Claims are made for acupuncture's usefulness in treating a plethora of ailments from indigestion to headaches to gingivitis. Those with neuromuscular diseases may come across promises, on the Internet and elsewhere, that acupuncture has the potential to treat serious illnesses such as those covered in MDA's program.

It's best to greet all such claims with profound skepticism. Anecdotal reports aside, there's no scientific evidence to prove acupuncture has any effect on the course of a neuromuscular disease, says Robert McMichael, a neurologist and director of the MDA clinic at Neurology Associates of Arlington, Texas.

It should also be said that, from the point of view of Western medicine, there's no reliable evidence to support the notion that such concepts as Qi or meridians are medically valid.

However, some studies do suggest that acupuncture may be effective in alleviating certain kinds of pain and relieving nausea caused by anesthesia. Still other research suggests acupuncture isn't helpful in chronic pain.

"As far as affecting weakness, there's no reason why it should do that," McMichael says. "But there's reasonable evidence that acupuncture relieves pain, at least temporarily."

The mechanism by which acupuncture helps with pain is unknown. It may be that, by affecting the nervous system, acupuncture is able to stimulate the production of certain chemicals within the body that promote a sense of well-being.

Point 2: Don't Get Stuck With an Infection

"I've seen advertisements for acupuncture claiming it would treat cholesterol and heart disease and things that it couldn't possibly help, at least as far as any rational understanding of it would tell us," says McMichael.

He warns that needles should never be reused from one acupuncture session to the next. If they are, infection can result. The Food and Drug Administration requires that acupuncture needles be labeled "for single use only."

Needles shouldn't be used on sensitive or infected skin. If these safeguards are followed, acupuncture's not liable to be physically harmful.

"Acupuncture's mostly dangerous to your wallet if it doesn't work," says McMichael.

Point 3: Vague Hopes Lead to Disappointing Results

In answer to a question sent to "Ask the Experts" on MDA's Web site about the use of acupuncture for back pain in amyotrophic lateral sclerosis, neurologist Robert Miller replied: "There really is no role for electrical stimulation or acupuncture in ALS."

Miller, director of the Forbes Norris MDA/ALS Research Center in San Francisco, says manual stretching by family members and caregivers is preferable for pain relief.

McMichael believes that, for people with ALS, the FDA-approved ALS drug Rilutek should be given higher priority than alternative therapies such as acupuncture.

Thomas Tinti, of Sacramento, Calif., arranged for several months of acupuncture for his stepdaughter, Luda Gogolushko, 13, who has spinal muscular atrophy.

She's been using a wheelchair for about five years and has started to develop a spinal curvature. Her family decided to try acupuncture to help prevent further scoliosis.

As with muscle weakness, Mc-Michael says there's no evidence to support the notion that acupuncture would help at all with spinal curvature.

"From a scientific standpoint, I don't think we could say whether or not there was any benefit," says Tinti. "We are now doing a number of other things — yoga, swimming, good diet, some herbs, massage, stretching — as part of Luda's therapy. Despite these efforts, Luda's back is curving more and more and my guess is that she will be recommended for back surgery soon."

Point 4: It Can Help With Pain

In the United States, some practitioners of acupuncture are doctors, but many aren't.

Acupuncture is part of the tradition of holistic medicines, which consider the entirety of the patient, including overall physical and emotional health. This is in contrast to the Western tradition of focusing on one problem at a time.

"I think this is an ancient art that has been used to treat pain, but we in Western medicine haven't accepted it," says Sue Ingle, 43. She lives in Loomis, Calif., near Sacramento, where she works as a waste management specialist, concerned with recycling plastics.

Ingle found out she had Charcot-Marie-Tooth disease when she was in her 20s. At the time she was told she'd need an operation on her feet, but she opted to wait.

Several years ago, she turned to acupuncture for the ongoing pain she experiences related to her CMT, got some relief, then discontinued the treatment.

Last June, she experienced a resurgence of discomfort. "What's happening is my ankles are degrading so quickly that the more I was walking, the more pain I was having," she says.

The long-delayed surgery now seemed necessary, and the number of pain pills she was taking doubled. Ingle decided she needed help from acupuncture once again.

Luckily, her insurance covers acupuncture treatment, requiring her to make only a $5 co-pay per treatment.

Ingle discussed her pain situation with the acupuncture practitioner and spoke in general terms about her disease.

"I told him the worst part is usually around my knees and then it goes down my legs to my toes. So usually when he puts the needles in he will surround my knee with needles and then it goes down on the outside around the leg, and then he puts them in strategic places in my arches and in my toes."

She started going weekly, and continued the treatments before and after undergoing major reconstructive surgery on her right foot in November. She says the acupuncture sessions have helped control the discomfort and cut her need for pain medication in half. Increased comfort means she's also able to sleep better.

Point 5: It Can Be Relaxing

Ingle describes the acupuncture experience as follows:

"It takes an hour. I have them target my toes and my lower legs or wherever I'm having pain that week. In fact, before surgery, he put a needle in the top of my head, which was to promote energy and the immune system. Before he puts the needles in he wipes down the area with alcohol.

"All the needles are sterile. They come right out of the package. No needles are reused.

"When the needles go in, sometimes you don't feel anything and sometimes you feel a pinprick. I would say four out of five times during the session, I will fall asleep. That one time I don't fall asleep, it kind of hurts.

"You never know what you are going to feel like. Sometimes I feel like jumping off the table and dancing, and other times after he puts the needles in I just totally fall asleep."

Sometimes the practitioner applies electric probes to the inserted needles, creating a different sensation, Ingle says. "It'll come in waves. Sometimes when he hooks those up is when I fall asleep. I can hardly stay awake. "When he takes the needles out, it's just the most incredible feeling of warmth and of circulation. Immediately, you feel wonderful, and it carries with you for several days.

"What I've found is, after about a week, if you are having really bad pain, you really need to go back because your body tells you it's worn off.

"I think half of acupuncture is going in there and believing it's going to help. I really do. I think half of it's in the head," Ingle says.

"If somebody has a pain that they want to get relief from, I think it's reasonable to try acupuncture," McMichael says. "But then they have to decide how useful it is after experiencing it."