Public interest in complementary and alternative therapies,both for the maintenance of wellness and the treatment ofdisease, has grown rapidly in the United States in recentyears.Integrating complementary and alternative treatmentapproaches shown to be effective into the current mainstreamhealthcare system in a well-regulated environment is animportant step toward achieving goals set forth by the U.S.Department of Health and Human Services in Healthy People2010.Unfortunately, putative mechanisms of many suchtherapies remain unclear, and the need for quality researchevaluating integrative clinical practice remains. In this chapterwe discuss complementary and integrative medicine with afocus on traditional Chinese medicine (TCM) and, morespecifically, acupuncture for pain control.
HISTORICAL CONSIDERATIONS:
With the arrival of the 21st century, a multibillion dollarindustry in complementary and alternative medicine (CAM)has emerged.Overall estimates of CAM use in the UnitedStates range from 28.9% to 42%.1-5 To maximize the benefitto public health and ensure quality of care, in 1998, the U.S.Congress established the National Center for Complementaryand Alternative Medicine (NCCAM) at the National Institutesof Health (NIH).
The purpose of the NCCAM is to stimulate,develop, and support CAM-related research.Furthermore, inresponse to public demand for more information and guidance, the White House Commission on Complementary andAlternative Medicine Policy was created in March, 2000.
Among the recommendations made by the commission were(1) federal agencies should receive increased funding for clinical, basic science, and health services research of CAM therapies; (2) the federal government should consider enactinglegislative and administrative incentives to stimulate privatesector investment in CAM research of products that may notbe patentable; (3) federal, private, and nonprofit sectorsshould support research of CAM modalities and approachesdesigned to improve self-care and promote wellness; and (4)these sectors should support innovative CAM research of corequestions posed by new areas of scientific study that mightexpand our understanding of health and disease.
Additionally, the World Health Organization (WHO)established specific objectives regarding CAM use thataddress policy; safety, efficacy and quality; access; andrational use.The challenges of meeting these objectives aremany, but considering the global economic and public healthimpact of CAM, they are challenges that must be addressed.
Efforts by the WHO and the US government to establishmeaningful healthcare policies regarding CAM are extremelyimportant for ensuring the safe and appropriate use of thesetherapies.
History of Acupuncture:
TCM is a complete system of healthcare that has been practiced in China for thousands of years. According to the WHO,TCM is used to treat at least 200 million people annually andaccounts for nearly 40% of all healthcare provided in China.The primary disciplines within TCM include acupuncture,herbs, and food therapy; Tui na, or Chinese bodywork; Taichi (therapeutic exercise); and Qi gong (meditative/energytherapy). Acupuncture is among the most popular of thesetherapies and is used in at least 78 countries worldwide.
In the West, acupuncture therapy has grown substantiallymore common over the past few decades. In 1971, JamesReston, a journalist for the New York Times, wrote a frontpage article describing how his postoperative pain from anemergency appendectomy was relieved by acupuncture whiletraveling in Beijing. Three months later, a group of USphysicians visiting hospitals in China observed acupuncturefor surgical analgesia and reported their observations in theJournal of the American Medical Association. Growingpublic interest ensued, and in 1972, President Richard Nixon,accompanied by his personal physician, witnessed severalsurgeries using acupuncture-assisted anesthesia. The NIHsubsequently sponsored a team of physicians to study thehealthcare system in China; as a result, several studiesattempting to elucidate the underlying mechanisms of actionfor acupuncture were initiated, textbooks of TCM were translated into English, and training programs were established.
Before President Nixon’s visit to China, little informationabout acupuncture was available in the United States. Thereis documented evidence, however, of acupuncture being usedin clinical practice as early as 1826, when Franklin Bache, aPhiladelphia physician and grandson to Benjamin Franklin,concluded in a published report that he had found acupuncture to be an effective treatment for pain due to rheumatismand neuralgia among prisoners at the Pennsylvania state penitentiary.Sir William Osler also endorsed acupuncture as aneffective treatment for lumbago and sciatica in The Principles.
