Western medical acupuncture: a definition

This seminal article presents a formal definition of Western medical acupuncture (WMA), representing an important milestone in the evolution of acupuncture practice. The authors, led by Adrian White and the editorial board of the journal Acupuncture in Medicine, propose an approach that adapts traditional Chinese acupuncture to modern scientific knowledge of anatomy, physiology, pathology, and evidence-based medicine. WMA differs fundamentally from traditional Chinese acupuncture by abandoning concepts such as Yin/Yang and qi (氣) circulation, positioning itself as part of conventional medicine rather than a complete alternative medical system. The historical development of WMA dates back to the 19th century, when British physicians began applying needles at points of maximum tenderness to relieve musculoskeletal pain.

The modern impulse owes much to Felix Mann, who in the 1970s declared that "acupuncture points and meridians, in the traditional sense, do not exist," resonating with practitioners who observed clinical benefits but questioned traditional explanations. The mechanisms of action of WMA are well grounded in neurophysiology. Sensory nerve stimulation constitutes the main mechanism, with overlap with the effects of transcutaneous electrical stimulation and spinal cord stimulation. Local effects include antidromic axonal reflexes that release neuropeptides such as calcitonin gene-related peptide, increasing local nutritive blood flow.

At the spinal and brain level, there is solid evidence that acupuncture promotes the release of opioid peptides and serotonin. Clinical effects on musculoskeletal pain are explained by inhibition of nociceptive pathways in the spinal dorsal horn, activation of descending inhibitory pathways, and possible local or segmental effects on myofascial trigger points. Functional magnetic resonance imaging and positron emission tomography studies demonstrate effects on several brain centers involved in pain control, particularly limbic structures including the insula. WMA practice occurs predominantly through physicians, physical therapists, nurses, and other health professionals working in the Western health system, mainly in primary care, but also in rheumatology, orthopedics, and pain clinics.

The most widespread application is in pain relief, especially musculoskeletal pain, but also other forms of chronic pain such as neuralgia and cancer pain. Less frequently it is used to suppress procedural and postoperative pain or nausea, although it has proven effective in these situations. Current clinical evidence mainly supports its efficacy (compared with placebo) in the relief of nausea and various types of pain. WMA treatment follows a conventional medical examination, appropriate investigations, and diagnosis confirming that the symptoms are suitable for acupuncture treatment.

Needles are inserted and stimulated to achieve the necessary physiological effect, which may be local or segmentally related to the presenting condition. WMA practitioners generally pay less attention than classical acupuncturists to the choice of one specific point over another, although they generally choose classical points as the best sites for stimulating the nervous system. Implications for acupuncture research include the need for more information on the appropriate "dose" of stimulation for particular conditions and the recognition that sham acupuncture probably represents a less effective form of therapeutic needling rather than an inert placebo. Systematic reviews demonstrate that acupuncture is significantly superior to sham for nausea, low back pain, postoperative pain, knee pain, and tension headache.

Limitations include the need for more clinical trials and the fact that treatment in many clinical areas still relies on clinical experience due to insufficient evidence.