Acupuncture: its use in medicine
Pearl et al. · Western Journal of Medicine · 1999
Evidence Level
MODERATEOBJECTIVE
Review the scientific literature on acupuncture and provide guidance for its integration into Western medicine
WHO
Patients with chronic pain, postoperative nausea, and various other conditions
DURATION
Review of evidence from 1969-1996
POINTS
Several condition-specific points, including PC-6 for nausea
🔬 Study Design
Literature review
n=0
Analysis of multiple meta-analyses and clinical trials
📊 Results in numbers
Patients treated annually in the US
Estimated annual spending
Physicians who have referred for acupuncture
Insurers covering acupuncture
Percentage highlights
📊 Outcome Comparison
Efficacy by condition
This landmark 1999 study was pivotal in establishing acupuncture as a recognized treatment in Western medicine. It shows that acupuncture is effective for postoperative pain and nausea, with minimal risks when properly practiced. Communicating with your physician about acupuncture use is important for integrated care.
Article summary
Plain-language narrative summary
This historic 1999 article represents a milestone in the integration of acupuncture into Western medicine, offering a comprehensive review of the scientific evidence available at the time. The study contextualizes the exponential growth of acupuncture in the United States, where more than one million people received treatment annually, generating a $500 million market. The analysis reveals that 43% of physicians had already referred at least one patient for acupuncture, and 70-80% of insurers covered the treatment. The article presents both the traditional Chinese perspective, based on the concept of qi (氣) and meridians, and the Western scientific explanation, focusing on the mechanism of endorphin release and other neurotransmitters.
The review examines multiple meta-analyses and identifies solid evidence for the efficacy of acupuncture in postoperative dental pain, postoperative and chemotherapy-induced nausea and vomiting, and nausea of pregnancy. For low back pain, headache, and neck pain, the evidence is promising but inconsistent across studies. The 1997 NIH Consensus Panel is highlighted as official validation of the efficacy of acupuncture for specific conditions. The authors address crucial methodological issues, including the challenge of defining adequate placebos and the difference between 'classical' (individualized) versus 'formula' (protocolized) acupuncture.
The Lao study is cited as an example of a well-developed placebo, using empty plastic tubes and superficial skin manipulation. Regarding safety, the review identifies infection and trauma as the main risks, with 126 cases of hepatitis and 65 cases of pneumothorax reported in the 1969-1996 literature, resulting in five deaths over the period. These data emphasize the importance of adequate regulation, appropriate sterilization, and universal precautions. The article discusses practical strategies for integrating acupuncture into conventional medical practice, suggesting specific questions to initiate discussions with patients about complementary therapies.
Legal issues are addressed, clarifying that medical referrals to competent and licensed acupuncturists generally do not expose the physician to legal liability. Professional training is detailed, noting that in 1995 there were approximately 10,000 certified acupuncturists in the United States, one-third of whom were physicians. The Council of Colleges of Acupuncture and Oriental Medicine (CCAOM) and the American Academy of Medical Acupuncture (AAMA) are presented as important regulatory organizations. The article concludes that, in the era of evidence-based medicine, acupuncture deserves consideration as a reasonable therapeutic option for specific conditions, especially considering its favorable safety profile compared to other interventions.
The authors emphasize the importance of physician-patient communication and adequate monitoring when acupuncture is used as adjuvant therapy.
Strengths
- 1Comprehensive review of the literature through 1996
- 2Balanced analysis of Eastern and Western perspectives
- 3Practical discussion of clinical integration
- 4Critical evaluation of research methodology
Limitations
- 1Inconsistent evidence for many conditions
- 2Methodological challenges in defining adequate placebos
- 3Limited long-term safety data
- 4Need for more high-quality studies
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
This 1999 article functions as a period document that captures the moment acupuncture definitively crossed the threshold of evidence-based medicine in the United States. For the contemporary clinician, the value lies less in the epidemiological numbers — now superseded — and more in the reasoning the text builds around therapeutic integration. The distinction between individualized classical acupuncture and protocolized formula acupuncture remains clinically relevant: patients with postoperative dental pain, chemotherapy-induced nausea, and hyperemesis gravidarum constitute the populations with the strongest support in this review and remain solid indications in our current arsenal. The fact that 43% of physicians were already referring patients for acupuncture in 1999 signals that the conversation about integration is not new — what has changed is the quality of the evidence and the need for the physician to actively guide this reasoning with the patient, rather than merely react to spontaneous demand.
▸ Notable Findings
The safety data deserve detailed attention: across 27 years of compiled literature, 126 cases of hepatitis and 65 cases of pneumothorax were identified, with five deaths. In absolute terms, for a practice serving more than one million patients per year in the US, these figures reflect an extraordinarily low risk profile compared with nonsteroidal anti-inflammatory drugs or interventional procedures. The proposed mechanism — endorphin release and neurotransmitter modulation — already pointed at that time toward the neurobiology that decades later would underpin functional neuroimaging studies on the effect of acupuncture on pain processing circuits. Another point that remains current is the explicit recognition by the 1997 NIH Consensus Panel, conferring institutional legitimacy that paved the way for 70-80% coverage by US insurers, a phenomenon that to this day guides discussions on incorporation into public health systems.
▸ From My Experience
In my practice at the Pain Center, this article circulated among residents as required reading for years, not for its methodological robustness but for teaching how to frame the conversation with the patient. I have observed that oncology patients on chemotherapy respond to acupuncture for nausea control with notable frequency — I typically see perceptible benefit by the second or third session, which facilitates adherence. For chronic musculoskeletal pain, the response profile is more variable: I generally work with cycles of eight to twelve sessions before reassessing, always combining with supervised therapeutic exercise, since the combination potentiates and sustains the functional gain. Patients with uncontrolled coagulopathy, local infection, or intense needle anxiety are practical contraindications I clearly outline. What this article captures well — and what I continue to see day to day — is that the physician must be the conductor of this integration, not a passive observer of what the patient has already decided to do on their own.
Indexed scientific article
This study is indexed in an international scientific database. Check your institutional access to obtain the full article.
Scientific Review
Marcus Yu Bin Pai, MD, PhD
CRM-SP: 158074 | RQE: 65523 · 65524 · 655241
PhD in Health Sciences, University of São Paulo. Board-certified in Pain Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. Scientific review and curation of every entry in this library.
Learn more about the author →Medical disclaimer: This content is for educational purposes only and does not replace consultation, diagnosis, or treatment by a qualified professional. Some information may be assisted by artificial intelligence and is subject to inaccuracies. Always consult a physician.
Content reviewed by the medical team at CEIMEC — Integrated Centre for Chinese Medicine Studies, a reference in Medical Acupuncture for over 30 years.
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