Wang et al. described the use of a needle that looks rather like a scalpel for
the treatment of myofascial pain.^31 The second is a new form of sustained
stimulation by a plastic tube; this is introduced subcutaneously by a needle
and left in situfor 24 hours before removal.^32
The patient is usually treated lying down to minimise any tendency to
faint. As many as 15–20 needles may be inserted superficially at the appro-
priate point(s). The practitioner then gently introduces the needles a little
more deeply into the muscle, rotating them between finger and thumb. Qi
and blood flow throughout the meridians and this is where manipulation of
the needle is critical in properly moving this flow. The arrival of qicalled
deqiis signified by a dull ache or tingling sensation and slight inflammation.
Some practitioners may use electrical stimulation, connecting the needles to
a small piece of equipment powered by batteries. Needles are left in place
for up to 20 min: the patient is invited to lie back and relax. Occasionally a
needle may be left in place for several days, normally situated in the ear;
these so-called indwelling needles should not be used in patients with heart
valve disease or who are immunocompromised.
A single course of treatment usually comprises 10–12 sessions. Two or
three courses may be required for the treatment of chronic conditions.
Acupuncture point selection may vary at each treatment, depending on the
patient’s response. If significant improvement is achieved, the patient will be
discharged at the end of the treatment but will normally be instructed to
continue with other elements of TCM, e.g. dietary control and perhaps
exercises.
Evidence
The reader is referred to the comments made in the section on TCM above.
Evidence of effectiveness is largely restricted to case studies, although RCTs
are available for western acupuncture (see below). The findings of many of
these randomised trials have caused much debate. Positive trials have been
criticised because of inadequate blinding, and negative trials because the
intervention was not administered by properly trained practitioners or
control interventions may have had analgesic effects.^33
Cautious approval of some applications of acupuncture was given by the
US National Institutes of Health consensus development meeting in 1997.^34
The 12-member panel was asked to evaluate current evidence for the effi-
cacy of acupuncture and concluded that there is ‘clear evidence’ of efficacy
in the control of nausea and vomiting occurring in some patients postoper-
atively and in association with chemotherapy, and for the relief of post-
operative dental pain. The panel said that acupuncture was ‘probably’ also
effective in the control of nausea in early pregnancy. The British Medical
Association reached a similar conclusion in their report on acupuncture.^35 A
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