The Science Behind Acupuncture and Arthritis

For individuals with arthritis, can incorporating acupuncture with other therapies help manage pain and other symptoms?

Acupuncture For Arthritis

Acupuncture has been around for thousands of years and is a form of traditional Chinese medicine that utilizes needles inserted into various parts of the body to relieve pain and inflammation. The practice is based on the concept of life energy that flows throughout the body along pathways called meridians. When the energy flow becomes disrupted, blocked, or injured, pain or illness can present. (Arthritis Foundation. N.D.) Further research is needed to determine how the acupuncture therapeutic mechanisms work and the overall effectiveness. However, there is emerging evidence suggesting that acupuncture can provide symptom relief for individuals with joint pain, especially those with osteoarthritis and rheumatoid arthritis. (Pei-Chi Chou, Heng-Yi Chu. 2018)

Benefits

The actual method that reduces the pain and inflammation is still unclear. Theories include that the needles suppress inflammatory responses, improve blood flow, and relax muscles. Although acupuncture cannot cure or reverse arthritis, it may be useful for managing pain and decreasing associated symptoms, especially in combination with other therapies. (Pei-Chi Chou, Heng-Yi Chu. 2018)

Rheumatoid Arthritis

A systematic review of 43 studies, including humans and animals with rheumatoid arthritis, demonstrated varied results. Several studies showed improvement in symptoms and decreased biological markers of rheumatoid arthritis following one to three sessions of acupuncture for four weeks or more. (Sharon L. Kolasinski et al., 2020) Beneficial outcomes following acupuncture treatment for rheumatoid arthritis include:

• Reduced pain
• Reduced joint stiffness
• Improved physical function

The results of the human and animal studies suggested that acupuncture has the potential to down-regulate:

• Levels of interleukins
• Levels of tumor necrosis factor
• Specific cell signaling proteins/cytokines involved in the inflammatory response, which become elevated in autoimmune conditions like rheumatoid arthritis. (Pei-Chi Chou, Heng-Yi Chu. 2018)
• Most of the study subjects were also receiving other forms of treatment, especially medication. Therefore, it is difficult to conclude how beneficial acupuncture is alone or as a supplemental addition to other medical treatments. (Pei-Chi Chou, Heng-Yi Chu. 2018)

Osteoarthritis

Acupuncture for osteoarthritis of the hand, hip, and knee is recommended, according to the American College of Rheumatology and Arthritis Foundation, meaning that it may be worth trying, although more research is needed to confirm its effectiveness. However, since the risk is relatively minor, acupuncture is generally considered a safe alternative treatment option for managing the symptoms. (Sharon L. Kolasinski et al., 2020)

Chronic Pain

As clinical trials suggest that acupuncture may be effective in providing pain relief, it may be a recommended option for individuals suffering from chronic pain. A recent systematic review of 20,827 patients and 39 trials concluded that acupuncture is effective for the treatment of chronic musculoskeletal pain, headache, and osteoarthritis pain. (Andrew J. Vickers et al., 2018)

Other possible benefits include the antioxidative effects: (Pei-Chi Chou, Heng-Yi Chu. 2018)

• Alleviating oxidative stress and inflammation
• Improving energy metabolism
• Triggering the release of endorphins/hormones that help reduce pain.

Safety

• Acupuncture is considered a safe procedure by a licensed and certified professional.
• To practice acupuncture in the United States, an acupuncturist needs a minimum of a master’s degree from a program accredited by the American Academy of Acupuncture and Oriental Medicine and a license in the state where they received their acupuncture treatment.
• Doctors with an MD or DO degree licensed in the United States to practice medicine can also be licensed by the American Academy of Medical Acupuncture after additional training.

Risks

Risks associated with acupuncture are bleeding and bruising, especially for individuals who have a bleeding disorder like hemophilia or take a blood thinning medication. Individuals are recommended to talk to their healthcare provider to determine if acupuncture is a safe option.

Side Effects

Most individuals do not experience any side effects, although possible reactions can include: (Shifen Xu et al., 2013)

• Soreness
• Bruising
• Scarring
• Needle shock: a vasovagal response that presents as feeling faint, clammy hands, chills, and slight nausea.

Acupuncture Session

• During the initial treatment, individuals will discuss their medical history and what joints and areas of their bodies are presenting with symptoms.
• After a physical exam, the individual will lie on a treatment table.
• Individuals may be face up or down depending on what areas of the body the acupuncturist needs to access.
• It is recommended to wear loose clothing that can be rolled up or moved out of the way to access different areas easily.
• Depending on what areas need to be accessed, individuals may be asked to change into a medical gown.
• The acupuncturist will use alcohol swabs to disinfect the area before inserting the needles.
• The needles are made of stainless steel and are extremely thin.
• Individuals may feel a slight pinch in sensitive areas like the hands and feet, but needle insertion should be comfortable and well-tolerated without significant discomfort.
• For electroacupuncture, the acupuncturist will pass a mild electric current through the needles, typically 40 to 80 volts.
• The needles stay in place for 20 to 30 minutes.
• After the treatment is finished, the acupuncturist will remove the needles and dispose of them.

Frequency

• The frequency of acupuncture sessions will vary depending on the severity of the symptoms and whether the visits are approved and reimbursed by the health insurance company.

Cost and Insurance

• Costs for acupuncture can vary from $75 to $200 per session.
• The first session, which involves an initial assessment and evaluation, usually costs more than follow-up visits.
• Whether the health insurance will cover some or all of the costs of acupuncture sessions depends on the individual insurance company and the condition being treated.
• Medicare currently covers acupuncture services up to 12 visits within a 90-day period for chronic low back pain only.
• Medicare will not cover acupuncture for other conditions. (Medicare.gov. N.D.)

Acupuncture is not a cure for arthritis, but it may be a useful tool to help manage pain and other symptoms. Make sure to consult a healthcare provider if acupuncture is safe to try based on medical history.

Arthritis Explained

References

Arthritis Foundation. (N.D.). Acupuncture for arthritis (Health & Wellness, Issue. www.arthritis.org/health-wellness/treatment/complementary-therapies/natural-therapies/acupuncture-for-arthritis

Chou, P. C., & Chu, H. Y. (2018). Clinical Efficacy of Acupuncture on Rheumatoid Arthritis and Associated Mechanisms: A Systemic Review. Evidence-based complementary and alternative medicine : eCAM, 2018, 8596918. doi.org/10.1155/2018/8596918

Kolasinski, S. L., Neogi, T., Hochberg, M. C., Oatis, C., Guyatt, G., Block, J., Callahan, L., Copenhaver, C., Dodge, C., Felson, D., Gellar, K., Harvey, W. F., Hawker, G., Herzig, E., Kwoh, C. K., Nelson, A. E., Samuels, J., Scanzello, C., White, D., Wise, B., … Reston, J. (2020). 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis care & research, 72(2), 149–162. doi.org/10.1002/acr.24131

Vickers, A. J., Vertosick, E. A., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., Irnich, D., Witt, C. M., Linde, K., & Acupuncture Trialists’ Collaboration (2018). Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. The journal of pain, 19(5), 455–474. doi.org/10.1016/j.jpain.2017.11.005

Xu, S., Wang, L., Cooper, E., Zhang, M., Manheimer, E., Berman, B., Shen, X., & Lao, L. (2013). Adverse events of acupuncture: a systematic review of case reports. Evidence-based complementary and alternative medicine : eCAM, 2013, 581203. doi.org/10.1155/2013/581203

Medicare.gov. (N.D.). Acupuncture. Retrieved from www.medicare.gov/coverage/acupuncture