Acupuncture for SLE: Can it Work for You?

Acupuncture dates back at least 2500 years. It is based on Traditional Chinese Medicine (TCM), which describes patterns of vital energy - called qi - that flow through the body in specific channels or meridians. TCM believes that qi is essential for health and controls all bodily functions. The 12 main meridians correspond to the 12 major body functions. In TCM, the concept of health is based on the balance of qi; disruptions in the flow of qi cause imbalance and result in disease.

While Western medicine uses anatomic definition of body organs, TCM uses functional definitions. So while Western medicine defines "spleen" as an organ located on the left side of the abdomen, TCM uses "spleen" to refer to the functions of the digestive system.

In TCM, diagnosis defines an imbalance of qi based on: yin and yang, deficiency and excess, cold and heat, interior and exterior factors. The principle of treatment is to restore balance by stimulating the normal flow of qi. This can be done using: herbs; moxibustion (burning a dried herb above the skin surface), and acupuncture.

Types of Acupuncture

Chinese acupuncture involves the stimulation of specific "acupoints" with thin, metallic needles - by manual stimulation or by electrical stimulation. Such stimulation may be enhanced with moxibustion. Some practitioners massage the points (acupressure) instead of needling them.

In Japanese acupuncture, needle insertion is shallower than in Chinese acupuncture - just one of the differences. Korean and French acupuncture have their own differences as well

In the U.S., acupuncture for chronic pain follows two approaches:

• the holistic approach, based on TCM, in which needles are inserted in acupoints along the channels to restore qi balance; some of these points may be far from the area affected although they are believed to be connected through the meridian;
• the modern, modified approach treats symptoms as a regional pain syndrome and needles are inserted in the area where the pain occurs.

How Acupuncture is Believed to Work

Most acupoints are located near nerves, and nerves are believed to play a major role in how acupuncture works, although considerable controversy still surrounds this question. According to one theory, the acupuncture needle stimulates small diameter nerves in muscles, which send impulses to the spinal cord. The spinal cord and brain are then activated to release endorphins, which are the body's natural pain-killers.

The "de qi" response is a feeling of tingling, soreness and electrical sensation when the needle is inserted and may result from activating certain nerve fibers. Many acupuncturists use this response to judge whether they've hit the right spot.

Acupuncture Use in the U.S.

According the a 1998 study, more than one million Americans currently use acupuncture, and most use it for musculoskeletal problems. In 1997, a National Institutes of Health Consensus Development Conference on Acupuncture concluded that it is an acceptable treatment for the following: low back pain, osteoarthritis, tennis elbow, carpal tunnel syndrome, fibromyalgia, postoperative dental pain, menstrual cramps, and nausea from chemotherapy, pregnancy, and post-operative responses. Acupuncture may be safer compared to many standard therapies for these conditions. Other conditions for which acupuncture may be useful, in conjunction with more comprehensive management programs, include headache, asthma, addictions, and stroke rehabilitation.

While some research studies have shown that acupuncture was effective for back pain, reviewers have questioned those results because of the low quality of the studies. So effectiveness remains unclear.

A recent review of acupuncture for chronic pain (in conditions such as back or neck pain, fibromyalgia, rheumatoid arthritis, and headache) also provided limited evidence of effectiveness.

Very little research has been conducted on acupuncture for SLE. However, studies of patients with conditions such as arthritis suggest it may be helpful for the aches and pains associated with SLE. Some acupuncturists say that it also may help the fatigue associated with SLE but, again, there is no hard evidence. Also, there are no controlled studies to suggest that acupuncture will help nephritis, anemia, skin rashes, or other systemic symptoms of SLE. However, it is reasonable to give acupuncture a trial, in addition to conventional treatment, for relieving arthritis and muscle aches and pains.

Why Try Acupuncture?

If you do not feel you are getting adequate pain relief from standard treatments, you may want to explore integrative medicine. Acupuncture is just one part of integrative medicine, which draws on treatments from both mainstream and non-mainstream medicine to develop a treatment plan. It tries to combine the best medicine from both worlds. The Integrative Care Center at Hospital for Special Surgery has three acupuncturists.

Another possible reason for trying it is that standard therapies for pain may be giving you unpleasant side effects. Non-steroidal anti-inflammatory drugs (NSAIDs) can cause ulcers and other problems, narcotics may cause constipation, sleepiness and falls; and muscle relaxants may make you sleepy and cause falls.

However, acupuncture is not without side effects. The needles may cause minor aching, bruising, redness, lightheadedness and nausea. Rarely, acupuncture can lead to infections, nerve injury, and organ puncture. However, serious adverse effects are even less likely to occur in the hands of licensed acupuncturists.

If You Want to Try Acupuncture

If you want to try acupuncture, speak with the physician who treats your SLE first. Your doctor should be aware of any treatment you are using. Ideally, your physician and your acupuncture should communicate. Indeed, a referral from your doctor is the best way to find an acupuncturist.

Make sure your acupuncturist has experience treating SLE. Traditional acupuncturists often take a holistic approach. However, your physician may be more comfortable with an acupuncturist who is also a physician.

Tell your acupuncturist about all medications you are taking, and continue taking them. Do not take any herbs prescribed by an acupuncturist unless discussed with your physician.

What to Expect

During a treatment, expect to be positioned comfortably. Skin should be cleansed with alcohol. Needles should be single-use, sterilized, and disposed after use. Acupuncture needles are thinner than needles used for injections - so they do not hurt in the same way. Some people say there is no pain at all, while others compare it to a mosquito bite sensation. You may have the "de qi" experience of soreness, tingling or electrical sensations.

The depth of insertion varies depending on the part of the body being treated, from one to three centimeters - which is up to more than an inch. The needles may be twirled by hand or electrically stimulated. A warming lamp may be used. After insertion, you will be left alone for periods of 15 to 30 minutes, with periodic check-ups from the acupuncturist or assistant. You may find the treatment relaxing and fall asleep. However, be sure to ask how you can get assistance should your require it. (Some acupuncturists provide bells for you to ring.)

Acupuncture Costs

Acupuncture can cost from $60 to $100 per treatment. Some insurance companies cover acupuncture. Often you are required to pay out-of-pocket and take the responsibility for getting insurance reimbursement, if available. Check with your insurance plan to find out whether it will be covered. Medicare currently does not cover acupuncture.

You can also control costs by discussing with your acupuncturists when you should start seeing a response. For chronic pain, it's usually three to four weeks, twice a week, followed by a maintenance program of once a week or once a month. While this varies from patient to patient and the condition being treated, it's reasonable to agree on a limit on the number of treatments in advance.

If you cannot afford acupuncture, look into acupuncture clinical trials, such as those available at the Hospital for Special Surgery.

Learn more about the SLE Workshop, a free support and education group held monthly as HSS.