Acupuncture is among the oldest forms of pain intervention, dating as far back as 2600 BCE. Its use has been applied to patients with acute and chronic pain, but the mechanism of action remains unclear. Acupuncture has been a source of marked controversy in Western medicine because of the lack of clear understanding of its physiologic effects. One reason for this lack of understanding is that the points of stimulation in acupuncture are derived from ancient Chinese beliefs about disease processes and are frequently not related to known nervous system pathways.

Nonetheless, anecdotal evidence does support that the technique of acupuncture, if performed properly, can produce significant physiologic changes, some of which have pain-mitigating effects (Brown et al. 1974; Han and Tere-nius 1982; Mayer et al. 1977). These changes can include increasing endorphin levels within the central nervous system (CNS) (naloxone antagonizes the effectiveness of acupuncture); augmenting other neurotransmitters, including dopamine, serotonin, and norepinephrine (use of serotonin-blocking agents can reduce analgesic effects produced by acupuncture, whereas agents such as clomipramine may possibly augment acupuncture-induced analgesia); alteration of electroencephalograph^ and cortical evoked potentials; and other potentially beneficial physiologic effects (e.g., vasodilation). Acupuncture has been employed in a number of pain states, including headache, musculoskeletal pains, fibromyalgia, arthritis, bursitis, and synovitis.

Needles (20-100 gauge) are inserted at varying angles through the skin, corresponding to the areas that can mediate pain in various parts of the body. Once the needles are in place, stimulation at the insertion sites is produced by manual manipulation of the needles (e.g., rotated in place, oscillated, or raised up and down with a twirling motion) or through electrical stimulation. Electrical stimulation is less labor intensive and allows for more homogenous and consistent stimulation than manual manipulation techniques.

Fainting, seizures, infection, and pneumothorax (if needles are inserted into the trunk) are some of the potential complications. Needles can break after insertion, requiring surgical excision. When electrical currents are applied to the needle, localized skin burns can result. Patients receiving anticoagulants may be prone to bleeding and hemorrhage. Patients with rheumatic heart disease can develop bacterial endocarditis as a complication of acupuncture. Because of the changes in the vasculature arising from acupuncture, hypovolemic patients might be particularly prone to syncope. Acupuncture has led to spontaneous abortion in the first 3 months of pregnancy and thus should be avoided in the first trimester.

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Acupuncture For Cynics

Acupuncture For Cynics

Have You Always Been Curious About Acupuncture, But Were Never Quite Sure Where To Stick The Needles? If you associate acupuncture with needles, pain and weird alternative medicine then you are horribly misinformed about the benefits of the world's oldest form of medicinal treatment.

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