Acupuncture in Pain Medicine:
An Integrated Approach to the
Management of Refractory Pain
Farshad M. Ahadian, MD
Address
Center for Pain and Palliative Medicine, University of California,
San Diego, 9500 Gilman Drive, #0924, La Jolla, CA 92093-0924, USA.
E-mail: fahadian@ucsd.edu
Current Pain and Headache Reports 2002, 6:444–451
Current Science Inc. ISSN 1531–3433
Copyright © 2002 by Current Science Inc.
As the acupuncture nomenclature permeates medical
literature, the artificial barriers to integration
of acupuncture and allopathic medicine are disappearing.
More patients are looking to their physicians for
guidance on how to incorporate acupuncture into
their health care, and pain physicians are accepting
the challenge. Similar to allopathic medicine, acupuncture
is an intricate diagnostic and therapeutic system. However,
for practicing physicians, mastery of the skills necessary
for safe and effective treatment of many conditions is
well within reach. Used in an integrated medical
model, acupuncture is well suited to deal with many
of the functional problems that allopathic medicine
is not equipped to address. The result is patient and
physician satisfaction.
Introduction
Acupuncture originated in China more than 2000 years
ago, and it is one of the oldest and most commonly prac-
ticed medical disciplines in the world. In 1993, the US Food
and Drug Administration estimated that Americans made
9 to 12 million visits each year to acupuncture practitioners
and spent as much as $500 million on acupuncture treat-
ments [1]. In the past two decades, acupuncture popularity
has grown dramatically in the United States. In 1995, an
estimated 10,000 nationally certified acupuncturists
were practicing in the United States. That number was
estimated to have doubled by the year 2000. An estimated
one third of certified acupuncturists in the United States are
medical doctors [2].
This article begins with a review of the evolution of
acupuncture in the West and its integration into allopathic
medicine. The discussion then moves on to auricular
acupuncture, one of the subspecialties in medical acupunc-
ture and a powerful tool in the armamentarium of the pain
physician. Three case reports are discussed to demonstrate
some practical uses of these modalities and their inte-
gration into a busy clinical practice.
Acupuncture in the West
Knowledge of acupuncture made its way into the Western
world as early as the 17th century, beginning with the
presence of Jesuit missionaries in China. However, because
of its clash with the existing Western physiologic paradigm,
Western scientists dismissed it as working through
suggestion, distraction, or hypnosis. Despite this, interest
in acupuncture persisted in the shadows of allopathic
medicine; however, because of the lack of scientific
support, the evidence for acupuncture in the treatment of
illness remained anecdotal until the 1970s.
The first report regarding acupuncture that had wide-
spread exposure in the United States was by James Reston,
a journalist for the New York Times (The New York Times
July 26, 1971, 1:6). Reston had required an emergency
appendectomy while he was in China. His postoperative
pain and ileus had been treated with acupuncture, and
he was impressed enough with the results that he wrote
about it. The impact was so widespread that even the
Internal Revenue Service accepted acupuncture as a legit-
imate medical expense. In 1971, Dr. E. Grey Dimond
and Dr. Paul Dudley White were invited to the People’s
Republic of China. In December of 1971, the Journal of the
American Medical Association published “Acupuncture
Anesthesia,” which was Dr. Dimond’s report of this trip
[3]. The report included his first-hand observations of
multiple surgeries using acupuncture anesthesia. These
reports captivated the US medical community and marked
the beginning of the scientific exploration of acupuncture
in the United States. Because of the early reports of
acupuncture, anesthesia, and analgesia, the Western
medical community has been preoccupied with the use of
acupuncture in pain control. However, acupuncture is a
complete system of medicine that is equally applicable to
all aspects of healing [4].
Acupuncture in Pain Medicine: An Integrated Approach to the Management of Refractory Pain • Ahadian
State of the Science
The strongest initial evidence for the validity of acupunc-
ture was its efficacy in veterinary medicine and, sub-
sequently, in human infants, populations in which
suggestibility and placebo effects could not explain the
observed results [5–7]. Subsequently, it was shown in
animals, and later in humans, that real acupuncture caused
analgesia, and sham acupuncture did not. The initial stud-
ies were conducted on experimental pain models in which
placebo had a minimal impact relative to chronic pain
disorders. Several controlled trials of patients with chronic
pain also have shown a statistically significant difference
between acupuncture and placebo conditions [8]. Indeed,
more is known about the mechanisms of action of acu-
puncture than many pharmaceutic and physical agents in
routine use. Examples include the mechanism of action of
inhaled anesthetics in general anesthesia and the mecha-
nisms of action of anticonvulsants or spinal cord stimula-
tors used for chronic pain states.
Throughout the past three decades, several lines of evi-
dence have been explored to gain insight into the scientific
basis of acupuncture. The findings have been summarized
in chronologic order in Table 1.
Acupuncture Physiology
In 1979, the basic morphologic structure of an acupuncture
point was described by Senelar [9] based on the statistical
analysis of a large number of histologic sections of acupunc-
ture points in rabbits, cats, mice, and human cadavers.
Although the components of the acupuncture point
structure are not unusual in themselves, they are con-
centrated and organized in a distinctive fashion to form the
445
Figure 1. Schematic representation of
the peripheral and central nervous
system pathways involved in acupuncture.
acupuncture point. Senelar [9] described the acupuncture
point to be located in a vertical column of loose connective
tissue, surrounded by denser connective tissue of the skin.
Within the column of loose connective tissue, a lymphatic
trunk is coupled with an arteriole and a vein. The lympho-
vascular bundle is surrounded by a rich plexus of unmyeli-
nated cholinergic nerve fibers. The epidermis thins at the
surface of the acupuncture point and there is modification
of the collagen fibers (Fig. 1). Insertion of an acupuncture
needle primarily activates the A-δ fibers [10]. The A-β fibers
also may be activated. Deeper insertion may stimulate group
II and group III fibers. Calcitonin gene-related peptide
(CGRP) and substance P are released locally with associated
vasodilation and increased tissue temperature. At the level of
the dorsal horn of the spinal cord, interneurons segmentally
release dynorphin and enkephalin [11]. At the level of the
brain stem, the reticular formation (RF), the nucleus raphe
magnus (NRM), and the nucleus reticularis magnocellularis
(NRM) may be activated [12]. These nuclei trigger descend-
ing serotonergic and noradrenergic pathways that synapse
onto dorsal horn neurons, causing the release of enke-
phalin. The periaqueductal grey (PAG) at the level of the
midbrain also has descending enkephalinergic input. These
fibers activate the NRM and the reticularis magnocellularis
nuclei as they descend from the midbrain to synapse onto
the dorsal horn neurons in the spinal cord. Dynorphin and
enkephalin are the endogenous opiates generally found
from the spinal cord to the midbrain. In contrast, at the
level of the hypothalamic pituitary axis, β-endorphin is the
primary neuropeptide. Through these endorphinergic
pathways, the hypothalamus has widespread influence
throughout the central nervous system, including the
periventricular nuclei of the thalamus, the nucleus acum-
446 Anesthetic Techniques in Pain Management

Table 1. The scientific basis of acupuncture

Line of evidence Findings References
1.Bioelectrical properties 1. Acupoints have a lower electrical resistance than Niboyet [33,34]; Rabischong et al.
of acupoints the surrounding skin [35]; Roppel and Mitchell [36];
2. The electrical resistance between two acupuncture Hyvarinen and Karlsson[37]
points on the same classically described acupuncture
channel is lower than the resistance between two
acupuncture points on different acupuncture channels
3. The points and pathways of lowered electrical resistance
are bilaterally symmetrical, except for the anterior
and posterior midline.
2. Propagated sensation 1. Nondermatomal Bossy [38]; Eckman [39];
along acupuncture channels 2. Dependent on A-delta and C fibers MacDonald [40]; Kendall [41]
3. Blocked by local anesthetics, mechanical pressure, and ice
3. Technetium-99 1. Technetium-99 injection into acupoints reveals linear De Vernejoul et al. [42,43];
tracer studies spread topographically analogous to classically described Darras [44,45]
acupuncture channels.
2. Technetium-99 injection into non-acupuncture points
shows a centrifugal diffusion pattern
3. The rate of Technetium-99 linear spread increases
when the acupoint is stimulated
4. Rates of Technetium-99 linear spread do not correlate
with vascular or lymphatic circulation rates
4. Electrical propagation 1. Resistance to current passed between acupuncture points Mussat [46]; Reichmanis
along channels on the same classically described channel is less than et al. [47–49]
non-acupuncture points
2. If a current is introduced between two needles at one end
of an acupuncture channel after a latency period, a current
is detected between two needles inserted into the other
end of the same acupuncture channel
5. Morphologic studies 1. Approximate surface area is 1–5 mm Senelar [9]; Melzack et al. [50];
of acupuncture points 2. Points are commonly located in surface depressions Dung [51]; Terral [52];
along cleavage planes between muscles Bossy and Sambuc [53]
3. Most points may be identified by palpation and
may be hypersensitive
4. Histologically described as a column of loose, connective
tissue containing an arteriole, vein, lymphatic vessel,
myelinated nerves, and a rich plexus of unmyelinated,
possibly autonomic fibers, which are surrounded by thick,
dense connective tissue
6. Naloxone reversibility 1. Demonstrated in multiple mammalian organisms, Pomeranz et al. [54,56,58];
of acupuncture analgesia including humans Mayer et al. [55]; Cheng and
Pomeranz [57]
7. Increased CSF and 1. Demonstrated in multiple mammalian organisms, Sjolund et al. [59]; Clement-Jones
serum endorphin levels including humans et al. [31,60]; Hardebo et al. [61]
in response to acupuncture
8. fMRI 1. Acupuncture has regionally specific, quantifiable effects on Hui et al. [64]
relevant brain structures
2. fMRI appears to be a valid tool for studying the
CNS pathways affected by acupuncture
9. PET 1. Acupuncture has regionally specific, quantifiable effects
on relevant brain structures
2. PET imaging appears to be a valid tool for studying
the CNS pathways affected by acupuncture
CNS—central nervous system; CSF—cerebrospinal fluid; fMRI—functional magnetic resonance imaging; PET—positron emission tomography.

bens of the limbic system, the amygdala and diencephalon, nucleic acid also have been demonstrated to increase within
and the PAG [13–15]. The hypothalamic-pituitary-adrenal the spinal cord and higher centers after acupuncture, indi-
axis also controls serum cortisol levels. Cholecystokinin cating early gene expression. This may explain the cumula-
octapeptide, c-fos, and proenkephalin messenger ribo- tive and prolonged effects of acupuncture [16–20].
Acupuncture in Pain Medicine: An Integrated Approach to the Management of Refractory Pain • Ahadian
Figure 2. Schematic representation of the human external auricle
demonstrating its embryonic origin and rich neural innervation.
(CN V—cranial nerve V; CN X—cranial nerve X; C1, C2,
C3—first, second, and third cervical spinal nerves.)
Auricular Acupuncture
Citations of treatments using points on the ear are found
throughout the literature of many ancient cultures,
including Chinese and Persian medical writings and Egyp-
tian tomb paintings. The Hippocratic writings discuss cau-
terization and bleeding of the ear. Seventeenth and 18th
century European medical publications reported the use of
ear cautery to treat dental neuralgia and sciatica [4].
The scientific exploration and systematic charting of the
auricular correspondences were undertaken by Paul Nogier,
a French neurophysiologist, beginning in the early 1950s.
Nogier’s teaching and publications were disseminated from
France to Germany, and from Germany to China by way of
Japan. In the United States, the precision of the somatotopic
mapping was verified in a blinded experiment, showing
92% percent concordance between established medical
diagnoses and auricular diagnoses. Auricular acupuncture is
a treatment system based on normalizing the body's pain
and dysfunction through stimulation of points on the
ear. Resulting amelioration of pain and illness is believed
to be through the reticular formation and the autonomic
nervous system [21•].
Neuroanatomy of the External Ear
The external ear develops from embryonic gill plates. It
is made of tissue from each of the three embryonic layers:
ectoderm, mesoderm, and endoderm. It has a dense and
complex nervous innervation, including the greater auricular
nerve (C1, C2, C3) auriculotemporal branch of the tri-
geminal nerve (CN V), which has sympathetic fibers, and the
auricular branch of the vagus nerve (CN X), which has
par sympathetic fibers. The facial (CN VII) and glosso-
pharyngeal (CN IX) nerves also provide minor contributions
to the external auricle (Fig. 2).
447
Figure 3. Homuncular
arrangement of the
auricular reflex micro-
system originally
described by
Paul Nogier. An
inverted body is
topographically
represented on the
external auricle.
Physiologic Basis of Auricular Acupuncture
Auricular acupuncture is based on a reflex somatotopic
system organized on the surface of the external ear (Fig. 3),
which is one of many such microsystems in the body. The
speculative neuroanatomic model of this microsystem
consists of projections from visceral and somatic organs
and their somatotopic projections onto a modulating
center in the brain. After arriving at this central modulating
center, afferent signals from each organ trigger a change in
the corresponding somatotopic focus on the surface of the
ear. This change may be detected as a decreased sensory
threshold or as a decreased electrical resistance at the
somatotopic focus. Alternatively, stimulation of the
somatotopic focus may modulate afferent signals from the
corresponding organ (Gate Control Theory) or, through its
effect on the central modulating center, trigger a change in
the cerebral cortex or the end organ itself. The brain stem
reticular formation, with its inhibitory and excitatory influ-
ences on ascending and descending sensory, motor, and
autonomic impulses, appears to be the most likely central
modulating center. The auricular microsystem is useful as a
diagnostic and therapeutic modality.
Auriculotherapy is a sophisticated discipline of acu-
puncture that can be studied to a refined level of precision.
However, adequate skills necessary for safe and effective
treatment of more limited problems may be learned
quickly and are well within the reach of the allopathic
physician. The techniques may be used as a sole treatment
or may be easily combined with concurrent therapies.
Clinical Applications
Research shows that acupuncture is beneficial in treating a
variety of health conditions [16,22,23,24•]. According to a
consensus panel of scientists from the National Institutes of
448 Anesthetic Techniques in Pain Management
Health, researchers, and practitioners who convened in
November, 1997, clinical studies have shown that acupunc-
ture is an effective treatment for nausea caused by surgical
anesthesia, cancer, and for dental pain experienced after
surgery. The panel also found that acupuncture is useful
when administered alone or when combined with conven-
tional therapies to treat addiction, headaches, menstrual
cramps, tennis elbow, fibromyalgia, myofascial pain,
osteoarthritis, lower back pain, carpal tunnel syndrome, and
asthma, and to assist in stroke rehabilitation [25].
Acupuncture in Pain Medicine
There are three areas of pain medicine in which integration
of acupuncture with allopathic medicine offers distinct
advantages. These include musculoskeletal disorders, func-
tional disturbances, and chronic opiate therapy.
Musculoskeletal disorders
Because of the ongoing demographic change facing medi-
cine, musculoskeletal disorders will be a leading cause of
disability and decreased quality of life for the elderly popu-
lation. Because of advancing age and comorbidities, many of
these patients will not be surgical candidates or will choose
non-surgical alternatives. Furthermore, the untoward effects
of analgesic medications are not well tolerated in this group
of patients; therefore, their options are few. Acupuncture
offers an excellent choice. A recent prospective, controlled
trial comparing acupuncture with no treatment for patients
with advanced osteoarthritis of the knee who were awaiting
total knee replacement showed a highly statistically signifi-
cant difference between the groups. The acupuncture group
improved in walking, climbing stairs, and pain levels; the
control group deteriorated as time passed [26]. Although
knee osteoarthritis appears to be one of the best indications
for acupuncture, other common musculoskeletal disorders
such as cervical and lumbar facet disease, painful disorders
of the hip joint, and myofascial pain syndrome also are
appropriate indications [27–29].
Functional disturbances
The term functional disturbances is used by many physicians
to describe subjective complaints that are rarely associated
with positive physical or laboratory findings, definitive
medical diagnoses, or successful allopathic therapies. Such
complaints are common and can be major sources of dis-
satisfaction and decreased quality of life for patients. How-
ever, these premorbid states fit well within the acupuncture
diagnostic and therapeutic paradigms, which focus on
preventive care and promotion of homeostasis and vitality
rather than reversal of frank end organ dysfunction.
Aesthenic states and autonomic dysregulation dis-
orders are two types of functional disturbances particularly
relevant to pain medicine. Aesthenic states include chronic
ill-defined fatigue, dysthymia and mild depression, and
diminished libido. Autonomic dysregulation may manifest
as anxiety, sleep disturbances, and bowel dysfunction. It is
the rule, not the exception, for patients with chronic pain
to have several of these symptoms simultaneously. Failure
to address these disturbances frequently leads to failure of
treatment despite appropriate and conscientious use of
conventional therapies. Acupuncture offers a valuable tool
in the armamentarium of the pain physician for manage-
ment of functional disturbances.
Chronic opiate therapy
Administration of opiates for chronic pain states can no
longer be discounted as controversial and limited to patients
with terminal disease. It is now, and will continue to be,
a critical part of the overall management of intractable
malignant and non-malignant pain disorders. However,
regardless of the route of administration (oral, parenteral, or
intrathecal), obtaining long-term success with these agents
poses numerous challenges. Among others, these challenges
may include opiate side effects, physiologic tolerance,
psychogenic dependence, and withdrawal. Combined
opiate-acupuncture therapy is an invaluable technique for
achieving success with chronic opiate administration. Con-
current acupuncture treatments may be considered adjuvant
therapy, a concept well known to pain physicians. Twenty
percent to 50% reduction in overall opiate requirement is
not unusual after an initial course of acupuncture; the need
for dose escalation may be substantially reduced or elimi-
nated with acupuncture-maintenance therapy. Acupuncture
is a powerful tool for the management of situations in which
opiate withdrawal is a central issue. This may occur when
changing from one opiate to another (opiate rotation),
or when opiate therapy is discontinued. In animal studies,
electroacupuncture has been shown to reduce withdrawal
behavior by 50% [30]. For patients who are addicted to
heroin, electroacupuncture suppressed the clinical features
of withdrawal. In all of the patients who were observed,
successful treatment was associated with an increase in
cerebrospinal fluid met-enkephalin levels [31]. Auricular
electroacupuncture and naloxone have been used success-
fully to achieve rapid opiate detoxification in patients
with chronic pain [32].
Case Reports
Case one
A 54-year-old, medically retired, fighter pilot instructor had
an 8-year history of pain in the right neck radiating to the
scapula. His symptoms had started insidiously, related to
exposure to high G-forces, but escalated after a series of
parachute bailouts from crashing planes. Treatments for
pain before the presentation included six surgeries over the
right neck and scapular region, including muscle and
tendon releases and nerve transections, and an extensive
trial of multiple medications including anticonvulsants,
muscle relaxants, tricyclic antidepressants, a number of the
newer selective antidepressants, repeated trigger point injec-
Acupuncture in Pain Medicine: An Integrated Approach to the Management of Refractory Pain • Ahadian
tions, physical therapy, chiropractics, and massage. Four
years before this patient’s presentation, chronic opiate
therapy had been initiated with some improvement. How-
ever, his treatment course had been stormy. He had been
through several opiate rotations, each time requiring rapid
escalation of the drug (highest daily doses: 600 mg of
morphine, 500 mg of oxycodone, 150 mg of methadone,
and 150 µg/h of fentanyl transdermal patches). Further esca-
lation of opiates had been limited by side effects.
Two years after the initial institution of chronic opiate
therapy, the patient was referred for a trial of acupuncture. He
complained of inadequate pain control interfering with his
personal and social activities. His sleep hygiene was poor. He
described a constant, sharp, burning pain at the base of
his neck on the right side. The pain ranged from 7 to 10 on a
scale of 0 to 10. He also described muscle spasms in the
same region, which interfered with his ability to concentrate,
work, or sleep. His physical examination was remarkable
for taut bands of muscle spasm involving the right cervical
paraspinous muscles, the scalenes, the levator scapulae,
the rhomboids, and the erector spinae muscles in the
upper to-mid thoracic region. His surgical scars were well
healed. There were patchy areas of hypoesthesia and analgesia
related to the surgical procedures in his right neck and upper
back region. The active range of motion of the cervical spine
was moderately decreased with respect to extension, right-side
bending, and right rotation. His medications included 480
mg of morphine daily, 900 mg of gabapentin daily, 150 mg of
trazadone at bedtime, and 20 mg of citalopram daily.
The patient underwent an initial course of 10 weekly
electroacupuncture sessions. The treatments were selected
based on the French energetics system of acupuncture [4]
and included points on the extremities and the local region.
The frequency of subsequent maintenance treatment ses-
sions was gradually reduced to once monthly. Throughout
the initial 10-week course of therapy, the morphine dose was
reduced to 300 mg daily. Pain scores dropped to 3 to 6 on a
scale of 0 to 10. Subjectively, the patient remained
satisfied with this level of pain relief. The muscle spasms
were no longer present continuously, but heavy
physical activities such as working in the backyard still led to
increased spasms. His sleep also improved dramatically.
His use of trazadone was changed to an as-needed basis.
He has continued his monthly treatments for the past
2 years, with no change in his medication doses or the need
for opiate rotation.
Case two
A 44-year-old school librarian with migraine headaches
complained that she could no longer afford to pay her $300
monthly co-pay for intranasal stadol spray, which was being
prescribed for abortive therapy for her headaches. The
migraines primarily occurred around her menses for most of
her adult life. However, throughout the past 3 to 4 years, in
conjunction with early menopause, the headaches had
escalated in severity and had become a daily occurrence.
449
Dietary modifications and hormone therapy had failed to
reduce the intensity and frequency of the headaches.
Numerous triptans had been administered and failed
secondary to adverse effects. She was taking 120 mg of
propranolol daily for migraine prophylaxis. Intranasal
stadol spray had been prescribed as abortive therapy, but at
the time of presentation the dose had escalated to an hourly
basis, causing rebound headaches.
The patient underwent eight weekly acupuncture treat-
ments. These included a combination of body and auric-
ular electroacupuncture. At the time of the first treatment
session, the intranasal stadol spray was discontinued and
the patient was administered 40 mg of controlled-release
oxycodone daily in two divided doses. The patient was
given the option to return to the clinic for additional
auricular acupuncture treatments if she developed signs or
symptoms of opiate withdrawal or further escalation of
headaches. She exercised this option twice, once during the
first week of treatment and once during the second week.
By the eighth week of treatment, the frequency of head-
aches reduced to two episodes each week on the average,
and the intensity had decreased substantially. The patient
did not miss any more days of work.
Case three
A 56-year-old woman had post-thoracotomy syndrome,
which occurred as an iatrogenic consequence of laporoscopic
nissenfundoplication that was complicated by esophageal
perforation, mediastinitis, and pleuritis; it required chest
tube placement and prolonged mechanical ventilation.
Her care before this presentation included intercostal nerve
blocks, radiofrequency neurotomy, transcutaneous nerve
stimulation, and medication management including mor-
phine, methadone, gabapentin, mexiletene, baclofen,
amytriptilene, and trazadone. She complained of severe pain
along the lateral and anterior chest wall. The pain included
a sharp shooting component and a more diffuse, deep,
constant pain. The pain was not related to respirations, but
was exacerbated by movements of the left arm. Findings on
her physical examination included reproduction of sharp
pain by percussion over the well-healed chest tube scar along
the anterior axillary line on the left side, and diffuse myo-
fascial tenderness in the surrounding region. The myofascial
tenderness involved the pectoralis major and minor, the
latissimus dorsi, the subscapularis, the teres muscles, the
intercostals, and the serratus anterior. She also complained
bitterly of fatigue, insomnia, and loss of libido, which
were entirely new for her since her surgery. Methadone and
gabapentin were helpful, but caused daytime somnolence
and worsening of her fatigue and loss of libido. At the time of
her presentation, her medications included 40 to 60 mg of
methadone daily, 1800 mg of gabapentin daily, and 150 mg
of trazadone at bedtime.
Acupuncture treatment began with 10 weekly sessions.
During this time, the dose of methadone was reduced to 10
to 20 mg daily and the gabapentin was reduced to 900 mg
450 Anesthetic Techniques in Pain Management
daily. There were many episodes in which the patient
would forget to take her methadone because her pain level
was negligible. The patient stated that for the first time
since her surgery, she “felt like her old self again.” She
began doing arts and crafts again, which was an important
hobby for her that she had abandoned postoperatively. The
frequency of her treatments were gradually tapered to once
every 3 to 4 weeks, depending on her state of health; she
has continued her treatment for more than 3 years. Except
for minor fluctuations in dosages from time to time, her
medications remain unchanged.
Conclusions
Throughout the past three decades, traditional Western
concepts about acupuncture, which categorized this modal-
ity as naturalism, Confucianism, Taoism, or even distraction
and hypnosis, have given way to a wealth of scientific infor-
mation. Numerous randomized, controlled trials and more
than 25 systematic reviews and meta-analyses have evalu-
ated the clinical efficacy of acupuncture. With the help of the
National Center for Complementary and Alternative medi-
cine at the National Institutes of Health, many of the inher-
ent difficulties in performing clinical trials in acupuncture
are being addressed. More physicians are incorporating
acupuncture into their practices.
In the field of pain medicine, acupuncture is particularly
useful as a tool for the management of certain aspects of
chronic intractable pain disorders, for which allopathic
medical and surgical therapies have little to offer. These
include musculoskeletal disorders, functional disturbances,
and issues related to medication management, particularly
opiates. The three cases previously discussed illustrate
effective and practical integration of acupuncture and con-
ventional allopathic medical modalities to achieve superior
results that were not otherwise possible with each modality
alone. Of course, the possibilities are limited by each physi-
cian’s expertise and imagination.
References and Recommended Reading
Papers of particular interest, published recently, have been
highlighted as:
• Of importance
•• Of major importance
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States Patients, National Institutes of Health Consensus
Development Conference on Acupuncture, Program, and Abstracts.
Bethesda: November 3-5,1997. National Institutes of Health.
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Moulins-les-Metz; 1979:247–277.
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Sheng Li Hsueh Pao 1990, 42:523–533.
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