Acupuncture FAQ
Advanced Chiropractic & Acupuncture
Spinal Pain Solutions
What can acupuncture treat?
The diseases or disorders for which acupuncture therapy has been tested in controlled clinical trials reported in the recent literature can be classified into four categories as shown below. The following list ( 1-4 ) is from the World Health Health Orginization. 
1. Diseases, symptoms or conditions for which acupuncture has been proved-through controlled trials-to be an effective treatment:
Adverse reactions to radiotherapy and/or chemotherapy
    Allergic rhinitis (including hay fever)
    Biliary colic
    Depression (including depressive neurosis and depression following stroke)
    Dysentery, acute bacillary
    Dysmenorrhoea, primary
    Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastrospasm)
    Facial pain (including craniomandibular disorders)
    Hypertension, essential
    Hypotension, primary
    Induction of labour
    Knee pain
    Low back pain
    Malposition of fetus, correction of
    Morning sickness
    Nausea and vomiting
    Neck pain
    Pain in dentistry (including dental pain and temporomandibular dysfunction)
    Periarthritis of shoulder
    Postoperative pain
    Renal colic
    Rheumatoid arthritis
    Tennis elbow
2. Diseases, symptoms or conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed:

    Abdominal pain (in acute gastroenteritis or due to gastrointestinal spasm)
    Acne vulgaris
    Alcohol dependence and detoxification
    Bell's palsy
    Bronchial asthma
    Cancer pain
    Cardiac neurosis
    Cholecystitis, chronic, with acute exacerbation
    Competition stress syndrome
    Craniocerebral injury, closed
    Diabetes mellitus, non-insulin-dependent
    Epidemic haemorrhagic fever
    Epistaxis, simple (without generalized or local disease)
    Eye pain due to subconjunctival injection
    Female infertility
    Facial spasm
    Female urethral syndrome
    Fibromyalgia and fasciitis
    Gastrokinetic disturbance
    Gouty arthritis
    Hepatitis B virus carrier status
    Herpes zoster (human (alpha) herpesvirus 3)
    Labour pain
    Lactation, deficiency
    Male sexual dysfunction, non-organic
    Ménière disease
    Neuralgia, post-herpetic
    Opium, cocaine and heroin dependence
    Pain due to endoscopic examination
    Pain in thromboangiitis obliterans
    Polycystic ovary syndrome (Stein-Leventhal syndrome)
    Postextubation in children
    Postoperative convalescence
    Premenstrual syndrome
    Prostatitis, chronic
    Radicular and pseudoradicular pain syndrome
    Raynaud syndrome, primary
    Recurrent lower urinary-tract infection
    Reflex sympathetic dystrophy
    Retention of urine, traumatic
    Sialism, drug-induced
    Sjögren syndrome
    Sore throat (including tonsillitis)
    Spine pain, acute
    Stiff neck
    Temporomandibular joint dysfunction
    Tietze syndrome
    Tobacco dependence
    Tourette syndrome
    Ulcerative colitis, chronic
    Vascular dementia
    Whooping cough (pertussis)
3. Diseases, symptoms or conditions for which there are only individual controlled trials reporting some therapeutic effects, but for which acupuncture is worth trying because treatment by conventional and other therapies is difficult:

    Choroidopathy, central serous
    Colour blindness
    Irritable colon syndrome
    Neuropathic bladder in spinal cord injury
    Pulmonary heart disease, chronic
    Small airway obstruction
4. Diseases, symptoms or conditions for which acupuncture may be tried provided the practitioner has special modern medical knowledge and adequate monitoring equipment:

    Breathlessness in chronic obstructive pulmonary disease
    Convulsions in infants
    Coronary heart disease (angina pectoris)
    Diarrhoea in infants and young children
    Encephalitis, viral, in children, late stage
    Paralysis, progressive bulbar and pseudobulbar

Does acupuncture hurt?

Acupuncture needles are very fine gauge. Acupuncture needles are much thinner than needles (hypodermic syringes) used in vaccinations and injections. The needles that Dr. Bui & Dr. Hall use are literally the diameter of 5 human hairs. Many patients don't even feel them. The sensation of an acupuncture needle is a little bit like a mosquito bite and this is sometimes followed by a dull, heavy feeling around the needle.

Is acupuncture safe?

Only single-use disposable acupuncture needles are used at Advanced Chiropractic & Acupuncture. Occasionally spot bleeding occurs at the needle site, though because the needles are very fine, this is rare.

How long does a treatment take?

The first consultation,  a detailed history and exam will be performed, may take 1 hour. After the initial treatment, follow up treatments usually go for 15-30 minutes.

What are the side-effects of acupuncture?

There are very few doccumented side effects of acupuncture treatment. A feeling of euphoria, relaxation and general wellbeing is commonly experienced during and after the treatment and while this is not unpleasant, it may interfere with operating heavy machinery.
On very rare occasions, you may feel faint or nauseous during the treatment, in which case the practitioner will remove the needles and have you lie down for a few minutes until you feel better.
Occasionally there may be slight bruising around the acupuncture needle site. The bruises are usually no bigger than a dime, and clear within a few days. Note : if cupping is being performed it is very likely & normal for patients to have a brusie.

How many acupuncture points are used during a treatment?

This is a very difficult question as practitioners will often use different techniques depending on the condition. A general acupuncture treatment will require anywhere between 2 and 20 points, however in a recent survey most acupuncturists said 10-12 points was the average.

Can I have too much acupuncture?

Acupuncture two to three times a week is recommended during the initial "crisis - acute" stage of an injury or condition and this can be gradually reduced as patients improve. Guidelines want us to get patients to a point where they remain stable & improved at a month out without treatment.  Typically, after a patient has improved as is stable, we recommend a follow up / tune up in three months. Much like a dental cleaning or oil change.

Can Acupuncture and TCM be combined with other treatments?

As a general rule, acupuncture complements other treatments (including osteopathy, chiropractic and physiotherapy etc). It is important to inform other practitioners, including your GP, if you are having acupuncture or taking Chinese Herbal Medicines.  After inital exam, diagnosis, and care plan has been established  Dr. Bui & Dr. Hall will typically send a note to your GP. Please let the doctors know if you want them to send a note to your GP. Equally, it is important that you inform the doctors at Advanced Chiropractic & Acupuncture of other treatments you are having, or medications you are taking (including herbs and homeopathic remedies).

What do I wear?

There are acupuncture points all over the body. However, the most common points are on the arms and legs and on the back and abdomen (stomach). Wearing loose fitting, comfortable clothing is advised- to make points easily accessible and avoid any discomfort during the treatment.You may be asked to wear a gown.

Who should not have acupuncture?

There are a few medical conditions which are not suitable for acupuncture. These are:
* Psychiatrically unwell* Unable to give informed consent* Intoxicated persons (alcohol or other drugs)* Epilepsy* Bleeding diathesis (haemophilia or other blood disorders)

How long is a course of acupuncture?

This is a difficult question as acupuncture treatments will vary for each person depending on the condition. Having a minimum of 7 sessions of acupuncture is advised in the first instance. This can be three times a week, once a week for three weeks or even every second week for six weeks. Many practitioners advise it may take about six weeks of weekly treatment for a condition to be noticeably relieved.
After these initial treatments, additional sessions may be required. If the condition is more involved, up to 10-15 sessions may be required.  If you are not responding at 12th visit ( re-evaluation ) you will likely be referred for advanced testing ( MRI, CT, nerve conduction tests ) or referal to other specialist ( neurosurgeon, neurologist, internist, orthopedists,etc. )

Where are common acupuncture points located?

Most major acupuncture points are on the arms (from the elbow to the fingers) and on the legs (from the knee down to the toes). There are also major points on the back in the muscles along the spine, and on the abdomen (around the umbilicus).

How will I know if it is working?

Depending on your condition, it may take a few treatments before you see the effects of acupuncture. What you will experience immediately is a feeling of relaxation which is usually noticeable in the first few minutes of treatment and may last several hours and sometimes several days. The effects of acupuncture are accumulative- the more you have it, the more you notice the results. If you are not getting the treatment response you want, talk to your practitioner about other TCM treatment or other treatment modalities.

Can acupuncture be used for post-operative care?

If you have just come out of hospital, you may like to consider acupuncture and TCM as part of your post-operative care plan. This would mean you would see a GP, your hospital specialist and an acupuncturist to help speed up your recovery process. The GP will be responsible for ensuring there are no infections following surgery, whereas your acupuncturist will help with pain management as well as rebuilding your immune system- to support your body to heal itself during recovery.
It is important you inform your GP and hospital specialist that you have having acupuncture and TCM. It is also important that you let the doctors know what medication you have been prescribed. If you are unsure of what your medication is (or does), it is advised you talk to your GP or community pharmacist.

Difference between Manual and Electro Acupuncture
(Kong, 2002):

"Results showed that electroacupuncture mainly produced MRI signal increases in precentral gyrus, postcentral gyrus/inferior parietal lobule, and putamen/insula; in contrast, manual needle manipulation produced prominent decreases of MRI signals in posterior cingulate, superior temporal gyrus, putamen/insula. These results indicate that different brain networks are involved during manual and electroacupuncture stimulation. It suggests that different brain mechanisms may be recruited during manual and electroacupuncture."

What about Plaebo?

No. Acupuncture has been used to successfully treat cats, dogs, horses and other animals in a number of well-documented veterinary acupuncture studies. These animal patients do not understand or believe in the process that helps them get better.

How does it work?

The classical Chinese explanation is that there are channels of energy (qi or chi) that form regular patterns throughout the body. These energy channels, called "meridians," are like rivers flowing through the body to irrigate and nourish the tissues. An obstruction in the movement of these energy rivers is like a dam that backs up the flow in one part of the body and restricts it in others. Needling or otherwise stimulating the acupuncture points can influence the meridians. The needles help unblock the obstructions and re-establish the regular flow through the meridians. By harmonizing the flow of energy in the meridians, acupuncture can help correct imbalances in many of the body's systems, including the internal organs.
The modern scientific explanation is that needling the acupuncture points stimulates the nervous system to release chemicals in the muscles, spinal cord, and brain, including endorphins, enkephalins and other neurotransmitters. These chemicals will either change the experience of pain, or they will trigger the release of other chemicals and hormones which influence the body's own internal regulating system, bringing about a normalizing effect on neuroendocrine function.The compound adenosine is key to acupuncture's effectiveness, according to a study in Nature Neuroscience. Blocking enzymes that break down adenosine made the acupuncture much more effective, tripling the level of adenosine near the needle extended pain relief from about one hour to about three hours. The improved energy and biochemical balance produced by acupuncture results in stimulating the body's natural healing abilities, and in promoting physical and emotional well-being.

(National Institutes of Health, 1997): "Many studies in animals and humans have demonstrated that acupuncture can cause multiple biological responses. These responses can occur locally, i.e., at or close to the site of application, or at a distance, mediated mainly by sensory neurons to many structures within the central nervous system. This can lead to activation of pathways affecting various physiological systems in the brain as well as in the periphery. A focus of attention has been the role of endogenous opioids in acupuncture analgesia. Considerable evidence supports the claim that opioid peptides are released during acupuncture and that the analgesic effects of acupuncture are at least partially explained by their actions. That opioid antagonists such as naloxone reverse the analgesic effects of acupuncture further strengthens this hypothesis."

Regarding stimulation by acupuncture, the NIH report also writes:
    * Acupuncture may activate the hypothalamus and the pituitary gland, resulting in a broad spectrum of systemic effects.
    * Alteration in the secretion of neurotransmitters and neurohormones and changes in the regulation of blood flow, both centrally and peripherally, have been documented.
    * There is also evidence of alterations in immune functions produced by acupuncture.
    * Findings from basic research have begun to elucidate the mechanisms of action of acupuncture, including the release of opioids and other peptides in the central nervous system and the periphery and changes in neuroendocrine function. Although much needs to be accomplished, the emergence of plausible mechanisms for the therapeutic effects of acupuncture is encouraging.

One of the studies cited by the NIH was conducted by Abass Alavi, M.D., chief of nuclear medicine at the University of Pennsylvania Medical Center, who showed that acupuncture affects the flow of blood in the brain. He used SPECT (single photon emission computed tomography) to view the brains of four people with pain and five pain-free people who served as the control group. Dr. Alavi found that after acupuncture needles were inserted, all of the patients had increased blood flow to the thalamus, the area of the brain that relays pain and other sensory messages. Because the brains of the pain-free group showed the same reactions as those with pain, the changes in blood flow couldn't be attributed to placebo.

Advanced imaging - brain on acupuncture

PET-Scans of the brain during acupuncture: University of California Irvine professor and physicist Zang-Hee Cho, a member of the highly respected National Academy of Science, the inventor of an early version of the Positron Emission Tomograph, or PET scan, and a pioneer of the MRI scanner, both of which have revolutionized our ability to see into the body and brain, found that stimulation of the vision-related acupoint showed the same reaction in the brain as stimulation of the eye. As the acupuncture signal passes to the brain via nerves, it possibly stimulates the hypothalamus, the "executive center" of the brain, responsible for the production and release of hundreds of neurochemicals, Cho said.
Acupuncture: pain management coupled to immune stimulation (Gollub, 1999): "The phenomenon of acupuncture is both complex and dynamic. Recent information demonstrates that acupuncture may exert its actions on pain and immune processes. The coupling of these two systems occurs via common signaling molecules, i.e., opioid peptides. In this regard, we surmise that
     * opioid activation leads to the processing of opioid peptides from their precursor, proenkephalin, and
      the simultaneous release of antibacterial peptides contained within the precursor as well. Thus,
      central nervous system pain circuits may be coupled to immune enhancement.
    * Furthermore, acupuncture needle manipulation elicited signal increases bilaterally in the region of the primary and secondary somatosensory corticies in human brain as determined by magnetic resonance imaging.
    * The maps reveal marked signal decreases bilaterally in multiple limbic and deep gray structures including the nucleus accumbens, amygdala, hypothalamus, hippocampus, and ventral tegmental area.
    * Taken together, we surmise a major central nervous system pathway as well as local pain and immune modulation during acupuncture."

(Fu, 2000): "In recent years, more and more laboratory proof has accumulated that acupuncture can

    * change the charge and potential of neurons,
    * the concentrations of K(+), Na(+), Ca(++) and
    * the content of neuro-transmitters such as aspartate, and taurine and the quantities of neuro-peptides such as beta-endorphin and leu-enkephalin.
    * All these phenomena are directly related to nerve cells."

(H. Fu, Med Hypotheses (2000) 54: 358-9)

Effects of Acupuncture on the Musculoskeletal System

Acupuncture can strengthen tendons and ligaments, stimulate Golgi receptors and muscle spindles, deactivate trigger points, treat overactive motor points, provide blood and growth factors to hemodynamically disturbed tissues (commonly seen in myofascial pain syndromes), reset motor points and neural control (possibly including replacement of oversensitive tissues with less sensitive microscars), and stimulate other reflex mechanisms.

Strengthen Tendons & Ligaments

Needling may strengthen soft tissues such as tendons and ligaments by inducing a local inflammatory reaction:
    * The mechanical trauma that results from needling may injure cells, including mast cells and vessels.
    * Blood products (such as platelet growth factors and transforming growth factor beta) spill and activate healing.
    * Amines and other mediators of inflammation are set free or are newly-formed locally, generating an acute inflammatory reaction.
    * Plasma seeps into the tissues, possibly allowing blood to reach poorly-vascularized areas such as ligaments and tendons. After a delay of a few hours, the plasma begins to attract polymorphs. In the absence of significant bacterial infection, this leukocytic infiltration is mild and fades quickly.
    * Macrophages migrate into the area of inflammation and work to remove red blood cells, fibrin, dead polymorphs and other cellular material. At the same time, with granulocytes, the macrophages work to activate fibroblasts.
    * Local fibroblasts begin to hypertrophy and to generate collagen and elastic fibers. If foreign matter such as an injection of pomess (flower) solution is left in place, (or acupuncture suture burial-a TCM surgical technique) it causes a foreign matter response. This response, which includes invasion of giant cells and a strong fibrous reaction, adds strength to the tissue.

Stimulate Golgi Receptors & Muscle Spindles

Many acupuncture points are based on nerve arrangement. According to Gunn, two types are in muscles, principally in motor points and Golgi tendon organs (Gunn 1977). Rotation of a needle in hypertonic muscle tissues can tug on muscle fibers, not unlike the way thread rolls on a spool. This action seems to stimulate stretch-sensitive Golgi receptors and muscle spindles, which may account for the resulting muscle relaxation. Acupuncture points have been described as 2-8mm, cylindrical shaped, perforations within superficial fascia in which a neurovascular bundle runs (Heine 1988). They are intimately related to the distribution of nerve trunks, motor endplates and blood vessels (Dung 1984; Gunn ibid; Chan 1984). Kellner (1966) has shown two types of acupoints, receptor and effector, by histological studies. Therefore, acupuncture effects are closely related to the nervous system and achieved by complex mechanisms which integrate peripheral, ascending, descending and higher centers in the nervous system. The mechanisms of acupuncture's effects are thought to be largely neurochemical and neurophysiologic.

Deactivate Trigger Points

Muscle needling may provide blood products and wash away sensitizing substances, brake fibrotic tissue that have entrapped nerve endings, and/or replace hyperactive nociceptors with nonpainful microscars. Travell has reported that active myofascial trigger points can be treated with "dry needling". This also results in muscle relaxation, which reduces mechanical stress on tissues such as tendons, thereby allowing more effective healing.
Jessen et al. (1989) remarks that, even in trigger point injection, the most important factor may not be the injected substance; rather, it may be the mechanical effects of needling on the abnormal tissue and interruption of the trigger point's mechanism, if one has developed.

Treat Overactive Motor Points

Muscle motor points are points that are packed densely with sensory end-organs, causing muscle to be easily excitable and most liable to tenderness. In his writings on the relationship of motor points to acupuncture points and on their sensitivity to pain, Gunn (1976,1979) says that the practitioner can needle motor points to treat muscular pain and tension. The proposed mechanism is similar to that of needling techniques in other muscle tissues. Gunn postulates that growth factors released by injured cells and platelets also result in healing of mildly-demyelinated nerves.

Provide Blood & Growth Factors

Chronic muscle tension and spasm can cause reduced oxygen and other nutrient supply. This, in turn, can result in a small area of abnormal function and ectopic muscle facilitation. Bleeding, which can be an effect of needling, can break microscars in these areas, and can provide blood and growth factors to facilitate healing.

Alter Neural Control
Needling may alter neural control:

    * By neurotransmitter and endorphin stimulation.
    * By reflex action such as stimulation of inhibitory fibers by a fusimotor mechanism.
    * By saturation of joint receptors. Stimulate Reflex Mechanisms

Opioid System

Early reports on the analgesic mechanism of acupuncture involved opioid systems. These reports may have contributed to, and at least supported, the discovery of the endorphin systems (Han 1986). In 1975, the year endorphins were discovered, David Mayer documented that acupuncture affects the opioid system in his demonstration that, in humans, naloxone can block acupuncture analgesia. (N.B. Naloxone is a chemical that can block opioid receptors.) Naloxone has also been shown to block the analgesic effect of acupuncture on dental pain (the affects are influenced by dexamethasone levels), (Mayer, Price and Rafii 1977).
The newly discovered orphanin (opioid peptide) seems to have antagonistic effects on electroacupuncture analgesia (Han 1998).
The analgesic effects of acupuncture can be enhanced by D-phenylalanine and D-leucine, which enhance met-enkephalin degradation (Ehrenpreis 1985; Han 1991), or by bacitracin (Zhang, Tang and Han 1981). (N.B. Bacitracin is a peptidase inhibitor, the injection of which results in increased neuropeptides. Met-enkephalin degradation results in a net gain in opioid-like chemicals). In a review, Pomeranz et al. (1977) concluded that acupuncture analgesia implicates the pituitary endorphins. They postulate that this is so, because placebo acupuncture is not as effective, the analgesic effect of acupuncture can be eliminated by ablation of the pituitary gland, and that naloxone is effective in blocking the analgesic effects of acupuncture.

Non-Opioid Systems
Non-opioid systems are affected by acupuncture:

    * Serotonin (5-HT), norepinephrine, GABA, calcium and magnesium ions, and secondary central cyclic nucleotides (Han 1987), and acetylcholine have been implicated in acupuncture analgesia (Guan, Yu, Wang and Liu 1986).
    * Dopamine is implicated in inhibition of acupuncture analgesia (Patterson 1986).
    * Anti-inflammatory effects have been elicited by stimulation of 17-hydroxycorticosterone, ACTH and cortisol secretion (Ying 1976; Omura 1976; O'Connor 1981).
    * Inflammatory mediators can affect pain perception as beta-endorphin levels can be affected by ACTH. This is because ACTH can antagonize the enzyme cleavage from a large, precursor, proopiomelancortin (Smock and Fields 1980). Sin has summarized these anti-inflammatory effects of acupuncture (Sin 1984)

The Thalamus

The thalamus is thought to be the most important component responsible for the processing of pain impulses and/or integration of pain sensation. The centromedian nucleus of the thalamus, the rephe magnus nucleus, and the arcuate nucleus seem to be the main areas related to acupuncture analgesia (Zang 1980; Hamba and Toda 1988; Yin, Duanmu, Guo and Yu1984). Peripheral stimulation of an acupuncture point was observed to stimulate thalamic neurons with a similar pattern in a cat (Liner and Van Atta 1975).

Descending & Ascending Tracts

Innocuous stimulation of peripheral nerves may excite descending inhibitory serotinergic tracts that then can inhibit nociceptors (Bowsher 1991). The descending dorsolateral funciculus of the spinal cord seems to be involved in acupuncture analgesia. Lesions made at T1-T3 levels resulted in complete abolition of acupuncture analgesia (Shen, Tsai and Lan 1975). Lacerating the contralateral anterolateral columns eradicated the analgesic effect from stimulation of St-36, whereas, laceration of the dorsal column at the level of T12-L1 or superficial lateral cordectomy did not affect acupuncture analgesia (Chiang et al. 1975). Cephalically, impulses produced by acupuncture analgesia are believed to be transmitted through the extralemniscal system (a bundle of sensory fibers in the medulla and pons), then to the thalamus and the sensory cortex.

How does Acupuncture work? / Research for the nerds

We know that it works from thousands of years of experience. Researchers have conducted scientific double blind studies to prove that it is not a placebo or hypnosis. Recently, researchers at the University of Medicine and Dentistry of New Jersey used functional magnetic resonance imaging (fMRI) to prove that acupuncture decreased certain brain activity in human volunteers experiencing pain. The decreased brain waves corresponded to lowered pain perception in the volunteers. Huey-Jen Lee, their chief neuroradiologist, stated "Western doctors have been reluctant to use acupuncture because they did not know why it was effective. Now we are learning more about the physical response created by acupuncture." Without a doubt, modern scientists have uncovered overwhelming scientific evidence that acupuncture works for many types of pain and disease. One only needs to tap the surface of readily available literature to encounter an exhaustive collection of scientific studies proving the efficacy of acupuncture...
Acupoints are tiny areas on the skin that contain relatively concentrated levels of nerve endings, lymphatics, and blood vessels. Stimulation from needling an acupoint initiates a complex cascade of events that have been studied, researched and grouped into Western theories that attempt to explain how acupuncture works.
Many theories have been proposed to explain the proven effects of acupuncture. It may be easiest to break the most plausible proposals into three summarized categories:
1) neurological     2) neuroendocrine     and     3) locally mediated.
1) Neurological: Pain perception is altered through acupuncture's effects on specific nerve fibers. The "gate theory" proposes that acupuncture at acupoints stimulates peripheral nerves which sequentially turn off specific nerve fibers in the central nervous system to effectively cease the transmission of pain impulses and modulate disease. This is way more complex than it sounds! This theory is probably responsible for some of the effects of acupuncture but on the basis of several studies, cannot stand alone to account for all of the known effects.
2) Neuroendocrine: Neurotransmitters such as beta-endorphin, met-enkephalin, serotonin, and Substance P modulate the effects of acupuncture, resulting in physiologic effects on the body. The key to this theory is the proposal that structures other than nerves are responsible for some of acupuncture's effects. Studies have shown that veins and cerebral spinal fluid carry neurotransmitters and hormones that mediate effects such as pain control. Increasing white blood cell levels is a known effect of acupuncture that probably involves both neuroendocrine transmitters and the nervous system.
3) Local Mediation: Due to the concentration of nerve endings, certain cells and vessels at acupoints, a relatively large integrated response is created when acupoints are needled. This response launches an elaborate cascade of enzymatic, chemical and vasoactive changes that play a role in the proven results of acupuncture.
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