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Home , Acupuncture

and MS THE BASIC FACTS

MULTIPLE SCLEROSIS

Acupuncture is one form of traditional Chinese that is widely used The theory throughout the world. In the United There are major conceptual differences States, acupuncture was relatively rare between Western medicine and traditional until the early 1970s. Since then, it Chinese medicine. For example, Chinese has grown quickly in popularity, and medical theory does not include the today, possibly a million Americans use concept of a nervous system. In Western acupuncture yearly. The frequency of and medicine, the nervous system acupuncture being used among people is seen as a critical component in with MS in the United States and Canada understanding and treating many diseases. is not known, but based on two large Furthermore, while “” (meaning surveys, it may be higher than in the that process “A” leads to process “B”) is general population. fundamental to many Western concepts, Chinese thought assumes that the world is a web-like array of many interrelated processes that cannot be viewed in isolation or in one-to-one relationships with each other.

Acupuncture and MS | 1 Acupuncture, and traditional Chinese medicine generally, is based on a complex The procedure theory of body functioning that involves a flow of , or “,” through 14 main Acupuncture refers to a group of procedures pathways, or “meridians,” in the body. that involve stimulating specific locations on There is also a balance of opposites the skin. Most often, this involves the insertion known as “yin” and “yang.” According of thin, solid, metallic needles into points on to traditional Chinese medicine, disease the body’s “meridians”. It is believed that this states are thought to be a consequence of alters the flow of energy and thereby produces disrupted energy flow and/or imbalances. improvement. There are approximately 400 acupuncture points, but usually only four to Attempts have been made by scientists to twelve points are used in a single session. explain some of the -relieving effects of acupuncture in Western terms. It has Other methods for stimulating the skin are been hypothesized that acupuncture may also used. The acupuncture points can be work by altering the levels of chemical stimulated by: messengers in the body. Specifically, n finger pressure, which is known as acupuncture may release “opioids” that or, in Japan, decrease pain. Other hypotheses propose n small heated cups placed on the points that acupuncture decreases stress or acts as (“cupping”) a . (Improvement occurs because n , which uses electrically the patient strongly believes the treatment stimulated needles is beneficial.) n “” in which smoldering fibers of In one study using a special type of an herb (Asian or “moxa”) are placed magnetic resonance imaging (MRI), on the points, or used to heat needles after insertion acupuncture at certain sites produced changes in brain activity. These changes, some of which occurred in pain-relevant brain regions, were present during the Studies in MS time in which the pain-relieving effects Few clinical studies have been conducted were present. to assess acupuncture effectiveness in people In the end, it may be found that multiple with MS. One preliminary study conducted processes are involved in acupuncture’s in Canada evaluated whether acupuncture pain-relieving effects—or that current might improve bladder function in people Western biological concepts are with MS. This well designed but small study insufficient to explain the processes. (involving 41 people) suggested that bladder urgency and incontinence might be improved through the use of acupuncture. However, the effect varied depending on the particular acupuncturist performing the procedure.

Acupuncture and MS | 2 Several other reported trials of acupuncturein were acupuncture-related improvements in MS involved very small numbers of people anxiety, , dizziness, and urinary and were not well designed. It is difficult to difficulties. draw any conclusions based on those studies. It is important to remember that people in Two large surveys—one in the United these studies did not have MS. It cannot be States and one in Canada—have been assumed that these same effects would be conducted involving people with MS experienced by people who do have MS. and acupuncture. Although the results of surveys are not as convincing as those from clinical trials, they are an important Effects on the method for generating ideas for further research. The preliminary findings of both studies are similar. In each, 20–25% of the It is important for people with MS to ask respondents who said they have MS had if acupuncture has an effect on the immune tried acupuncture, and 10–15% of those system, since inflammation and MS attacks who tried it indicated that they planned to are associated with certain overactive immune continue using it. In both surveys, pain, functions. At this time, however, the issue spasticity, and numbness or tingling were is not well understood. Studies focusing on among the symptoms most frequently acupuncture’s effects on the immune system reported to be improved. Other symptoms have been done in people with several forms of that were frequently reported to be improved cancer and . Acupuncture by acupuncture included fatigue, depression, has been associated variously with stimulating, anxiety, and bowel or bladder function. inhibiting, and having no effect at all on the immune system. Due to these mixed results, Studies in people further studies are needed. without MS Risks and side effects A large number of studies have assessed acupuncture for other medical conditions. In general, acupuncture is a very well tolerated To evaluate these studies in an objective procedure, especially when performed by a manner, the National Institutes of Health well-trained acupuncturist. The NIH panel (NIH), created a 12-member panel in that evaluated acupuncture stated, “The 1997. Based on research data and clinical occurrence of adverse events … has been experience, the panel concluded that documented to be extremely low.” The panel acupuncture is a reasonable treatment option concluded that acupuncture was,“remarkably for rehabilitation, headaches, and safe with fewer side effects than many well- pain (including facial pain, low , established .” and neck pain). Other studies suggested there

Acupuncture and MS | 3 Over a 20-year time period, only 216 serious n American Academy of Medical Acupuncture acupuncture complications have been reported www.medicalacupuncture.org; 310-364-0193 worldwide. Serious complications, such as n The American Academy of Acupuncture puncturing a , were associated with and Oriental Medicine www.aaaom.edu; 651-631-0204 acupuncturists who were poorly trained. n National Certifi cation Commission for There are other rare risks. To avoid Acupuncture and Oriental Medicine or AIDS, sterile disposable needles should www.nccaom.org; 904-598-1005 be used. People with valves that are damaged or prosthetic should probably not be treated with acupuncture to avoid the risk Acupuncture of infection. People who take blood-thinning medication (warfarin or Coumadin®) may combined with occasionally experience bruising or, more rarely, bleeding complications. Electro-acupuncture other asian therapies may produce heart rhythm abnormalities in Traditional Chinese medicine includes Chinese people with pacemakers, and the fumes from , qi gong, lifestyle advice, t’ai moxibustion may worsen breathing in people chi and exercise, as well as acupuncture. with . There are several important considerations regarding Chinese herbal medicine or, indeed, Practical information any type of herbal . Chinese herbal medicine involves treatment with complex Acupuncture is usually done once or twice mixtures of many different herbs. There may be significant variability in the quality and weekly. Sessions typically cost $45–$100. composition of these preparations. Some The length of time required for a course chemical compounds in the herbs may be toxic of treatment varies. If a beneficial response or may interact with prescription medications. occurs, it should usually be noted after six The safety of these herbal preparations in to ten sessions. The length of a complete people with MS has never been extensively course of treatment depends on the specific studied. symptoms and the underlying disease. For MS and other chronic diseases, a longer It is known that some of the herbs used treatment course may be necessary. in herbal medicine stimulate the immune system, which, theoretically, may be harmful In the United States, there are approximately to people with MS. Some of these potentially 30,000 licensed acupuncturists. There are harmful, immune-stimulating herbs include: 3,000 acupuncturists who have M.D. or D.O. Asian ginseng (Panax ginseng), dong quai training. Organizations that can be helpful (Angelica sinensis), astragalus (Astragalus in obtaining information about acupuncture membranaceus), coix, Epimedium sagittatum, and locating a trained acupuncturist include:

Acupuncture and MS | 4 reishi mushroom (Ganoderma lucidum), If acupuncture is used, it should only shiitake mushroom (Lentinus edodes), be used in addition to conventional Acanthopanax obovatus, Artemisia myriantha, medicine, in consultation with your Artemisia annua, Salvia Miltiorrhiza, Sophora physician or other licensed health-care flavescens, green tea, and licorice. professional. Asian is a form of herbal While acupuncture may be a reasonable medicine that typically includes herbs along option to manage some MS symptoms, in with minerals and animal parts. Several conjunction with conventional medicine, studies indicate that Asian patent medicine there is no evidence to suggest that may contain toxic ingredients. One study acupuncture can decrease the frequency found that approximately one-third of of MS exacerbations or the progression these preparations contained Western of disability. prescription drugs (including diazepam [Valium®], steroids, and prescription asthma By Thomas Stewart, J.D., M.S., PA-C, Rocky Mountain medications). Dangerous metals, including MS Center, Englewood, Colorado (www.mscenter.org) arsenic, mercury, lead, and cadmium, have and Allen Bowling, M.D., Ph.D., Neurology also been found. Care Englewood, Colorado (www.neurologycare.net)

While acupuncture is very low risk when Coumadin is a registered trademark of properly performed, there are many Bristol-Myers Squibb Pharma Co. uncertainties and some clear risks associated Valium is a registered trademark of Roche with Chinese herbal medicine. Asian patent Products, Inc. medicine, should be avoided due to the * The National Society is proud to possible presence of toxic contaminants. be a source of information about multiple sclerosis. Our comments are based on professional advice, published experience and expert opinion, but do not represent individual therapeutic recommendation Conclusion or prescription. For specific information and advice, consult your personal physician. Whether acupuncture is a good choice for people with MS is difficult to evaluate nationalMSsociety.org from a scientific perspective. It may be For Information: 1 800 FIGHT MS that acupuncture is helpful for certain (1 800 344 4867) MS related symptoms, including pain, spasticity, numbness and tingling, © 2014 National Multiple Sclerosis Society certain urinary symptoms, or depression. EG 0742 However, these symptoms, especially depression, should not be treated by acupuncture alone.

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