Acupuncture dates back at least 2,500 years. It is based on traditional Chinese medicine (TCM), which describes patterns of a vital energy or force called "qi" (sometimes spelled “chi,” “ch’i” or “ki), which flows through the body along specific channels called "meridians." In the philosophy of TCM, qi controls all bodily functions, and the proper flow of qi is essential for good health. Disruptions to that flow cause imbalances that result in disease.
The TCM principle of treatment is to restore balance by stimulating the appropriate flow of qi, and acupuncture is one method to do so. Acupuncture involves the stimulation of specific "acupoints" with thin, metallic needles – by manual stimulation or by electrical stimulation.
In the United States, acupuncture for chronic pain follows two different approaches:
Most acupoints are located near nerves, and nerves are believed to play a major role in how acupuncture works, although this remains a theory. 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 relievers. Clinical studies have shown that after acupuncture, endorphin levels in serum and cerebrospinal fluid increase from levels prior to treatment.
According a 1998 study, more than one million Americans used acupuncture, and mostly for musculoskeletal problems. In 1997, a National Institutes of Health Consensus Development Conference Statement concluded that acupuncture 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 postoperative 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.
There is not enough good quality research on acupuncture for lupus (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.
If you do not feel you are getting adequate pain relief from standard treatments, you may consider acupuncture.
Another possible reason for trying it is that standard therapies for pain may be giving you side effects. Nonsteroidal anti-inflammatory drugs (NSAIDs) and other pain relieving medications can be very effective but can also have negative side effects. NSAIDs may upset the stomach and cause constipation. Opioid pain relievers can constipation, sleepiness and lead to addiction.
However, acupuncture is not without side effects. In some people, the needles may cause minor aching, bruising, redness, lightheadedness and nausea. Very rarely, acupuncture can lead to infections, nerve injury or, if improperly administered, organ puncture. Adverse effects are less likely to occur in the hands of licensed acupuncturists.
For patients who are interested in trying acupuncture for their aches and pains, it is reasonable to do so. You should ask your rheumatologist about acupuncture, and whether he or she can recommend a licensed acupuncturist. You should maintain your usual medications under the direction of your rheumatologist. Since there is no evidence acupuncture can help with the more serious manifestations of SLE such as kidney disease, your lupus medications should never be discontinued for acupuncture treatment.
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.
During a treatment, you should 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.
The depth of insertion varies depending on the part of the body being treated. The needles may be turned 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 can be expensive, sometimes over $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 before you start treatments. Medicare currently does not cover acupuncture.
You can also control costs by discussing with your acupuncturists when you should start seeing a response. 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.
Learn more about the SLE Workshop, a free support and education group held monthly as HSS.
Summary of a presentation given at The SLE Workshop, a free support and education group held monthly for people with lupus and their families/friends. Summary prepared by Diana Benzaia.