The following is excerpted from the article "A Chinese Stroke Connection," Stroke Connection Magazine, March/April 2006
Dr. Peter Wayne is director of research at the New England School of Acupuncture in
Stroke Connection Magazine: Give us a plain-English explanation of acupuncture.
Dr. Wayne: Acupuncture is a form of therapy whose goal is to balance the flow of the internal energy of the body — or what the Chinese call Qi (pronounced chi). It relies on the insertion and manipulation of very fine needles into points on the body that have been mapped out for thousands of years. These points are organized on meridians or energy channels that correspond to what the Chinese refer to as internal organ systems.
The acupuncturist manipulates the flow of energy in the channels depending on the imbalance or condition that is being treated. Sometimes the needles are manipulated manually, sometimes with mild electrical stimulation, sometimes with heat.
There is a lot of investigation going on, but it is not easy to overlay any one Western medical map, such as the nervous system, onto acupuncture’s meridian system. For example, basic neurology finds it difficult to explain why it is that when we stimulate an acupuncture point in the leg, thought for thousands of years to improve vision, the optic center in the brain lights up.
SCM: How many people in the
Dr. Wayne: The number is growing, but the best estimate is that between 5 and 10 percent of adults have tried acupuncture. It’s becoming much more common to see acupuncture offered in traditional settings, like pain clinics.
SCM: How many practitioners are there in the
Dr. Wayne: About 13,000 – the number of practitioners tripled between 1992 and 2000 and is expected to quadruple by 2015.
SCM: Are there certifications patients should be aware of?
Dr. Wayne: Yes, there are two types of acupuncture certification. There is a four-year program that involves 3,000–4,000 hours of classroom and clinic work. Following that, the person must pass a national exam, then a state exam in many states. That produces either a Masters of Acupuncture or Masters of Acupuncture and Oriental Medicine. Patients should look for the designation L.Ac (Licensed Acupuncturist). A handful of programs offer doctorate level degrees (Doctor of Oriental Medicine; OMD).
Practicing physicians may also practice acupuncture by taking about 200 hours of course work. They’re “physician acupuncturists.” (Editor’s Note: Look for membership in American Academy of Medical Acupuncturists (AAMA) or American Board of Medical Acupuncture (ABMA).)
SCM: What kind of research have you been doing in the area of acupuncture and stroke?
Dr. Wayne: My most recent study involved people who have suffered stroke from as recently as six months prior to as long as 10 years ago. Our study was published in the December 2005 issue of Archives of Physical Medicine and Rehabilitation.
In it, 33 stroke survivors got either real acupuncture or sham acupuncture to test the placebo effect. We found that people who got up to 20 treatments of real acupuncture over 10 weeks saw improvements in spasticity and range of motion of the upper extremity.
We have another study ready for publication using the same group of survivors. That study found that the patients who experienced the greatest changes in upper extremity function also showed the greatest sensory motor cortex changes as measured with functional MRI.
SCM: Is there enough scientific evidence to make a definitive conclusion about the effectiveness of acupuncture?
Dr. Wayne: The jury is still out. Frankly, there haven’t been enough well-designed trials to come up with a firm conclusion. A recent analysis of acupuncture for stroke studies initially identified more than 1,100 citations; however only 12 of these studies were considered high enough quality to be included in this analysis. The analysis concluded there is no indication that acupuncture can improve motor function, but there is some indication that it has a positive effect on levels of disability, particularly improving activities of daily living (ADL). There are many issues that make it difficult to investigate acupuncture and draw conclusions, even from these higher-quality studies.
SCM: What can acupuncture do for stroke survivors?
Dr. Wayne: The results of the meta-analysis are telling evidence that acupuncture improves ADLs, such as self-care and walking. The patients we see in our clinics report that it improves the quality of life and mood, and their overall emotional well-being. They also report improved use of impaired limbs, speech, swallowing and other functions that are often impaired following stroke, but as I mentioned earlier, these observations are not always observed in controlled clinical trials. There are some positive studies, but there are others that contradict them. In our study there seems to be improvement of motor function, but it’s a pilot study. Equally important, acupuncture is very safe. In summary, I would not hesitate to recommend acupuncture to a friend or family member recovering from a stroke.
Editor’s Note: At this time, insurance reimbursement for acupuncture is rare. However, the situation is changing and currently differs from state to state and from company to company. Some policies pay for treatment if it is delivered by a physician acupuncturist; others pay if it is prescribed by a physician. Most, however, don’t cover acupuncture at all.