A licensed acupuncturist explains why the ancient Chinese practice may be beneficial for alleviating symptoms of MS.
By Gabrielle Gottlieb
When I chose a career in integrative healthcare and became an acupuncturist, it was out of a deep-rooted desire to empower patients to take an active role in their own health and wellbeing. As a practitioner, I help my patients gain a new perspective on what it means to be “healthy” by teaching them to “re-wind” and look inward so they can reexamine their lifestyle, thoughts and the behavioral processes and patterns that may be standing in their way.
Oriental medicine teaches that the cause of disease arises from emotional, spiritual, dietary and climatic dynamics as well as lifestyle. “Health” is a continuum with a fluid nature. For those who are managing a chronic disease like multiple sclerosis (MS)—with its spontaneous remissions and a continually changing and complex set of symptoms—it can be a challenging journey for the patient as well as for the practitioner.
During my externship at the Initiative for Women with Disabilities at the Hospital For Joint Diseases in New York City, I treated many courageous women living with MS for a variety of symptoms including: numbness and tingling in the limbs and face, transient weakness in the extremities, spasticity of the legs and hands, stiffness and fatigue of the limbs, gait disturbance, urinary incontinence, vertigo, depression and anxiety. Those who came for weekly sessions over a period of twelve weeks reported a reduction in the severity of their symptoms and regularly walked out of treatment with a newfound level of relief.
It is important to make clear that acupuncture’s effect is cumulative and, in the case of MS, requires multiple treatments for an extended period of time in order to reestablish a degree of balance in the body. The role of acupuncture in the treatment of MS symptoms is palliative, however, and as with any chronic condition, the sooner the treatment begins, the better the outcome.
Although acupuncture has been widely used to treat a variety of neurological disorders, there is an insufficient body of random, controlled, blinded, clinical trials pertaining specifically to the efficacy and safety of acupuncture for people living with MS. The few studies that do exist demonstrate only that acupuncture can provide short term, palliative benefits but that more accurate research trials are needed to determine its efficacy and to determine the role that acupuncture can play in the long- term care of those affected by MS.
Acupuncture can relieve pain and spasticity associated with M.S. while it improves locomotion, sensation, vision, energy, bladder control and immunity. With regard to bladder control, a randomized, placebo, controlled trial, for overactive bladder with urge incontinence, at the department of obstetrics and gynecology at Oregon Health and Science University in Portland, Oregon (see below) showed a 59% decrease in the number of incontinent episodes with the use of acupuncture. The women who received 4 weekly acupuncture treatments for urge incontinence showed significant improvement in bladder capacity, urgency frequency and improved quality of life as compared to women who received placebo acupuncture treatments.
Oregon Health and Science University in Portland Controlled Trial
85 women were randomized to receive an acupuncture treatment expected to improve their bladder symptoms, or to a placebo acupuncture treatment designed to promote relaxation. Before and after four weekly acupuncture treatments, these women underwent cystometric testing and completed a three-day voiding diary, urinary distress inventory, and incontinence impact questionnaire. Of the 85 participants, 74 completed the study. Both groups had significant decreases in number of incontinent episodes (59% for treatment, 40% for placebo) with no significant difference between groups. In the treatment group, there was a 14% decrease in urinary frequency, a 30% decrease in the proportion of voids associated with urgency, and a 13% increase in both maximum voided volume and maximum cystometric capacity. Urinary distress inventory and incontinence impact questionnaire scores improved in both groups (54% decrease with treatment, 30% decrease with placebo).
According to The National Multiple Sclerosis Society website, (nationalmssociety.org) two recent surveys conducted in the United States and in Canada show that of approximately 20-25% of study subjects with MS who tried acupuncture for symptomatic relief of pain, spasticity, numbness and tingling, fatigue, depression, anxiety and bowel and bladder difficulties, 10-15% indicated they would continue using it.
People often ask, “How does acupuncture work?”
Neurohormonal theory explains that pain transmission is modulated on many levels in the brain along pain pathways. Certain studies suggest that the pain relieving action of acupuncture is linked to the release of natural endorphins in the brain. FMRI studies have shown that when certain acupoints on the body are treated, specific areas of the brain “light up” validating that acupuncture increases the pain threshold, which also helps explain why it promotes long-term pain relief.
Acupuncture also increases blood circulation and influences white blood cell activity, the cells responsible for increased immunity to disease. According to the most recent research by the NIH, adenosine, a compound found in nucleic acids and energy carrying molecules in the body mediates the effects of acupuncture and that obstructing adenosine metabolism may prolong the clinical benefit of acupuncture. (See below.)
It is far more likely that traditional patients would try acupuncture if there was easy access to information and existing data regarding what it can and cannot do, what to expect in a clinical situation and if it were covered by health insurance.
Adenosine and Acupuncture
Nat Neurosci. May 30, 2010 Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture by N. Goldman, M. Chen, T.
Fujita, W. Peng, W. Liu, TK Jensen, Y. Pei, F. Wang, X. Han, JF Chen,
J. Schnermann, T. Takano, L. Bekar and M. Nedergaard. Excerpt from scientific research at the Center for Translational Neuromedicine, University of Rochester Medical Center, Rochester, New York:
We found that adenosine, a neuromodulator with antinociceptive properties, was released during acupuncture in mice and that its anti-nociceptive actions required adenosine A1 receptor expression. Direct injection of an adenosine A1 receptor agonist replicated the analgesic effect of acupuncture. Inhibition of enzymes involved in adenosine degradation potentiated the acupuncture- elicited increase in adenosine, as well as its anti-nociceptive effect. These observations indicate that adenosine mediates the effects of acupuncture and that interfering with adenosine metabolism may prolong the clinical benefit of acupuncture.
Acupuncture is gaining more acceptance in the United States, yet there is still a great deal of skepticism about it in the medical community and with the general public. Although acupuncture has been around for 5,000 years, this skepticism may be due in part to acupuncture’s philosophical methodology being rooted in empirical evidence and having a metaphorical basis that does not easily fit into the Western world’s scientific model of evidence-based medicine.
Eastern medicine and biomedicine, however, both agree on an interrelationship between bodily dynamics that are constantly in flux and that the goal of healthcare should be to sustain a general balance among the bodily systems to achieve wellness.
In the next issue, I will explain what actually happens in a typical acupuncture session.
Gabrielle Gottlieb is a New York City-based acupuncturist with a strong focus on women’s wellness.