Acupuncture and MST HE BA SI C FAC T SMULTIPLE SCLEROSISAcupuncture is one form of traditionalChinese medicine that is widely usedthroughout the world. In the UnitedStates, acupuncture was relatively rareuntil the early 1970s. Since then, ithas grown quickly in popularity, andtoday, possibly a million Americans useacupuncture yearly. The frequency ofacupuncture being used among peoplewith MS in the United States and Canadais not known, but based on two largesurveys, it may be higher than in thegeneral population.The theoryThere are major conceptual differencesbetween Western medicine and traditionalChinese medicine. For example, Chinesemedical theory does not include theconcept of a nervous system. In Westernscience and medicine, the nervous systemis seen as a critical component inunderstanding and treating many diseases.Furthermore, while “causality” (meaningthat process “A” leads to process “B”) isfundamental to many Western concepts,Chinese thought assumes that the world is aweb-like array of many interrelated processesthat cannot be viewed in isolation or inone-to-one relationships with each other.Acupuncture and MS 1
Acupuncture, and traditional Chinesemedicine generally, is based on a complextheory of body functioning that involvesa flow of energy, or “qi,” through 14 mainpathways, or “meridians,” in the body.There is also a balance of oppositesknown as “yin” and “yang.” Accordingto traditional Chinese medicine, diseasestates are thought to be a consequence ofdisrupted energy flow and/or imbalances.Attempts have been made by scientists toexplain some of the pain-relieving effectsof acupuncture in Western terms. It hasbeen hypothesized that acupuncture maywork by altering the levels of chemicalmessengers in the body. Specifically,acupuncture may release “opioids” thatdecrease pain. Other hypotheses proposethat acupuncture decreases stress or acts asa placebo. (Improvement occurs becausethe patient strongly believes the treatmentis beneficial.)In one study using a special type ofmagnetic resonance imaging (MRI),acupuncture at certain sites producedchanges in brain activity. These changes,some of which occurred in pain-relevantbrain regions, were present during thetime in which the pain-relieving effectswere present.In the end, it may be found that multipleprocesses are involved in acupuncture’spain-relieving effects—or that currentWestern biological concepts areinsufficient to explain the processes.The procedureAcupuncture refers to a group of proceduresthat involve stimulating specific locations onthe skin. Most often, this involves the insertionof thin, solid, metallic needles into points onthe body’s “meridians”. It is believed that thisalters the flow of energy and thereby producesimprovement. There are approximately 400acupuncture points, but usually only four totwelve points are used in a single session.Other methods for stimulating the skin arealso used. The acupuncture points can bestimulated by:n nger pressure, which is known as acupressurefior, in Japan, shiatsuns mall heated cups placed on the points(“cupping”)ne lectroacupuncture, which uses electricallystimulated needlesn“ moxibustion” in which smoldering fibers ofan herb (Asian mugwort or “moxa”) are placedon the points, or used to heat needles afterinsertionStudies in MSFew clinical studies have been conductedto assess acupuncture effectiveness in peoplewith MS. One preliminary study conductedin Canada evaluated whether acupuncturemight improve bladder function in peoplewith MS. This well designed but small study(involving 41 people) suggested that bladderurgency and incontinence might be improvedthrough the use of acupuncture. However,the effect varied depending on the particularacupuncturist performing the procedure.Acupuncture and MS 2
Several other reported trials of acupunctureinMS involved very small numbers of peopleand were not well designed. It is difficult todraw any conclusions based on those studies.Two large surveys—one in the UnitedStates and one in Canada—have beenconducted involving people with MSand acupuncture. Although the resultsof surveys are not as convincing as thosefrom clinical trials, they are an importantmethod for generating ideas for furtherresearch. The preliminary findings of bothstudies are similar. In each, 20–25% of therespondents who said they have MS hadtried acupuncture, and 10–15% of thosewho tried it indicated that they planned tocontinue using it. In both surveys, pain,spasticity, and numbness or tingling wereamong the symptoms most frequentlyreported to be improved. Other symptomsthat were frequently reported to be improvedby acupuncture included fatigue, depression,anxiety, and bowel or bladder function.Studies in peoplewithout MSA large number of studies have assessedacupuncture for other medical conditions.To evaluate these studies in an objectivemanner, the National Institutes of Health(NIH), created a 12-member panel in1997. Based on research data and clinicalexperience, the panel concluded thatacupuncture is a reasonable treatment optionfor stroke rehabilitation, headaches, andpain (including facial pain, low back pain,and neck pain). Other studies suggested therewere acupuncture-related improvements inanxiety, depression, dizziness, and urinarydifficulties.It is important to remember that people inthese studies did not have MS. It cannot beassumed that these same effects would beexperienced by people who do have MS.Effects on theimmune systemIt is important for people with MS to askif acupuncture has an effect on the immunesystem, since inflammation and MS attacksare associated with certain overactive immunefunctions. At this time, however, the issueis not well understood. Studies focusing onacupuncture’s effects on the immune systemhave been done in people with several forms ofcancer and rheumatoid arthritis. Acupuncturehas been associated variously with stimulating,inhibiting, and having no effect at all on theimmune system. Due to these mixed results,further studies are needed.Risks and side effectsIn general, acupuncture is a very well toleratedprocedure, especially when performed by awell-trained acupuncturist. The NIH panelthat evaluated acupuncture stated, “Theoccurrence of adverse events has beendocumented to be extremely low.” The panelconcluded that acupuncture was,“remarkablysafe with fewer side effects than many wellestablished therapies.”Acupuncture and MS 3
Over a 20-year time period, only 216 seriousacupuncture complications have been reportedworldwide. Serious complications, such aspuncturing a lung, were associated withacupuncturists who were poorly trained.There are other rare risks. To avoid hepatitisor AIDS, sterile disposable needles shouldbe used. People with heart valves that aredamaged or prosthetic should probably notbe treated with acupuncture to avoid the riskof infection. People who take blood-thinningmedication (warfarin or Coumadin ) mayoccasionally experience bruising or, more rarely,bleeding complications. Electro-acupuncturemay produce heart rhythm abnormalities inpeople with pacemakers, and the fumes frommoxibustion may worsen breathing in peoplewith asthma.Practical informationAcupuncture is usually done once or twiceweekly. Sessions typically cost 45– 100.The length of time required for a courseof treatment varies. If a beneficial responseoccurs, it should usually be noted after sixto ten sessions. The length of a completecourse of treatment depends on the specificsymptoms and the underlying disease. ForMS and other chronic diseases, a longertreatment course may be necessary.In the United States, there are approximately30,000 licensed acupuncturists. There are3,000 acupuncturists who have M.D. or D.O.training. Organizations that can be helpfulin obtaining information about acupunctureand locating a trained acupuncturist include:n merican Academy of Medical AcupunctureAwww.medicalacupuncture.org; 310-364-0193n he American Academy of AcupunctureTand Oriental Medicine www.aaaom.edu;651-631-0204n ational Certifi cation Commission forNAcupuncture and Oriental Medicinewww.nccaom.org; 904-598-1005Acupuncturecombined withother asian therapiesTraditional Chinese medicine includes Chineseherbal medicine, qi gong, lifestyle advice, t’aichi and exercise, as well as acupuncture.There are several important considerationsregarding Chinese herbal medicine or, indeed,any type of herbal therapy. Chinese herbalmedicine involves treatment with complexmixtures of many different herbs. There maybe significant variability in the quality andcomposition of these preparations. Somechemical compounds in the herbs may be toxicor may interact with prescription medications.The safety of these herbal preparations inpeople with MS has never been extensivelystudied.It is known that some of the herbs usedin herbal medicine stimulate the immunesystem, which, theoretically, may be harmfulto people with MS. Some of these potentiallyharmful, immune-stimulating herbs include:Asian ginseng (Panax ginseng), dong quai(Angelica sinensis), astragalus (Astragalusmembranaceus), coix, Epimedium sagittatum,Acupuncture and MS 4
reishi mushroom (Ganoderma lucidum),shiitake mushroom (Lentinus edodes),Acanthopanax obovatus, Artemisia myriantha,Artemisia annua, Salvia Miltiorrhiza, Sophoraflavescens, green tea, and licorice.If acupuncture is used, it should onlybe used in addition to conventionalmedicine, in consultation with yourphysician or other licensed health-careprofessional.Asian patent medicine is a form of herbalmedicine that typically includes herbs alongwith minerals and animal parts. Severalstudies indicate that Asian patent medicinemay contain toxic ingredients. One studyfound that approximately one-third ofthese preparations contained Westernprescription drugs (including diazepam[Valium ], steroids, and prescription asthmamedications). Dangerous metals, includingarsenic, mercury, lead, and cadmium, havealso been found.While acupuncture may be a reasonableoption to manage some MS symptoms, inconjunction with conventional medicine,there is no evidence to suggest thatacupuncture can decrease the frequencyof MS exacerbations or the progressionof disability.While acupuncture is very low risk whenproperly performed, there are manyuncertainties and some clear risks associatedwith Chinese herbal medicine. Asian patentmedicine, should be avoided due to thepossible presence of toxic contaminants.Coumadin is a registered trademark ofBristol-Myers Squibb Pharma Co.Valium is a registered trademark of RocheProducts, Inc.ConclusionWhether acupuncture is a good choicefor people with MS is difficult to evaluatefrom a scientific perspective. It may bethat acupuncture is helpful for certainMS related symptoms, including pain,spasticity, numbness and tingling,certain urinary symptoms, or depression.However, these symptoms, especiallydepression, should not be treated byacupuncture alone.By Thomas Stewart, J.D., M.S., PA-C, Rocky MountainMS Center, Englewood, Colorado (www.mscenter.org)and Allen Bowling, M.D., Ph.D., NeurologyCare Englewood, Colorado (www.neurologycare.net)* The National Multiple Sclerosis Society is proud tobe a source of information about multiple sclerosis.Our comments are based on professional advice,published experience and expert opinion, but do notrepresent individual therapeutic recommendationor prescription. For specific information and advice,consult your personal physician.nationalMSsociety.orgFor Information: 1 800 FIGHT MS(1 800 344 4867) 2014 National Multiple Sclerosis SocietyEG 0742Acupuncture and MS 5
Traditional Chinese medicine includes Chinese herbal medicine, qi gong, lifestyle advice, t’ai chi and exercise, as well as acupuncture. There are several important considerations regarding Chinese herbal medicine or, indeed, any type of herbal therapy. Chinese herbal medicine involves treatment with complex mixtures of many different herbs.