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A skilled acupuncturist often can relieve pain associated with acupuncture in a single session. Repeated sessions sometimes help rebuild bone. But there are reasons acupuncture doesn't work for everyone.

Acupuncture is an ancient method of pain relief. Limited clinical trials confirm that acupuncture helps many patients (although not every patient) recover from the pain of osteoporosis, when it is used in the context of a broader set of treatments.

How does acupuncture work?

Acupuncture is a technique from Traditional Chinese Medicine that involves placing needles at specific points on the body to cause a physiological or metabolic change or to modify emotions or to relieve pain. If you ask a Western-trained acupuncturist how acupuncture works, you will probably get an explanation in terms of the flow and blockage of a mysterious spiritual energy called chi. If you ask a doctor trained in the People's Republic of China, you will probably be told that chi is a metaphor and mnemonic for a technique that works very well for which there is no comprehensive explanation. 

Scientists have confirmed that different types of pain-relieving endorphins flow when different electrical frequencies are applied to acupuncture needles. Brain imaging studies find that acupuncture remaps the pathways for pain signals in the brain. Studies have found that acupuncture modifies protein synthesis in the connective tissues surrounding bone. Harvard professor Dr Ted Kaptchuk has done work that indicates that even people who believe that acupuncture is "just a placebo" can experience a beneficial placebo effect, making the scientific understanding of how acupuncture works even more mysterious. But the most important thing about acupuncture for osteoporosis pain is that it really is often effective.

Three clinical trials of acupuncture for osteoporosis

Chinese physicians reporting their findings in the Journal of Clinical Acupuncture and Moxibustion recruited 80 osteoporosis patients that they divided into to two groups. One group received calcium, vitamin D, and calcitonin (a hormone to encourage bone to absorb calcium) for eight weeks. The other group received calcium, vitamin D, calcitonin, and "acupuncture" for eight weeks.

In China, herbal medicine and acupuncture are considered to be two different ways of doing the same thing. In the metaphorical terms of Traditional Chinese Medicine, both acupuncture needles and herbs redirect the mysterious energies of chi. An herbal medicine is just another way of changing the flow of chi. In the study, the "acupuncture" group received both treatment with needles and treatments with herbs.

At the end of eight weeks, 80 percent of the patients in the supplements plus calcitonin group reported less bone pain. But 92.5 percent of the patients in the supplements plus calcitonin plus acupuncture reported improvement. There were increases in bone mineral density in the acupuncture group. The scientists concluded that acupuncture relieves pain, and two other hospitals had similar results. But while there are very specific acupuncture points for needling, herbal medicines are not precisely measurable, so the results of any Chinese study of how acupuncture is not strictly "scientific." The expectations of the patient probably pay a major role in its success.

Will acupuncture work for your osteoporosis pain?

Most people in the Western world have a problem with traditional Chinese acupuncture. The needles are thick. They are applied with pressure. They hurt. This kind of acupuncture seems to get reliable results, but many patients just don't want it.

Western acupuncturists tend to use thinner needles and to use a variety of methods to avoid pain and the fear of pain. They may use "laser acupuncture" or "color acupuncture" or tuina, Chinese massage, applied to acupressure points. They take care to build up expectations in patients to get the full benefit of the placebo effect. 

"Juicing up" acupuncture with electricity has objectively demonstrable effects on pain. When electric current with a frequency of 2 Hz, two pulses a minute, is sent through acupuncture needles, scientists have been able to show that the brain generates its own opioids to counter the inflammatory effects of a group of chemicals known as cytokines. Electroacupuncture increases production of the neurochemicals norepinephrine and serotonin, which stops a chemical reaction on spinal N-methyl-D-aspartate receptor subunit GluN1 that transmits pain to the brain. These effects may also occur with needles that have not been electrified, but they are only demonstrated for electroacupuncture.

The best way to approach acupuncture for osteoporosis is "Try it, it might work". And if it does, even if no one knows how, you will have achieved pain relief without risk of addiction, without digestive upset, without sleepiness or mood swings, and you can always go back for more. But if you want even better results from Traditional Chinese Medicine, let your doctor use a method called moxibustion. Four clinical trials suggest that adding this method of treatment that maybe it's better to let the doctor describe to you increases the benefits of acupuncture plus herbs, all the while continuing nutritional supplements and conventional anti-osteoporosis medications. Even if youthink that it "can't work," but you also know that our brains have ways of making us feel better on cue, you just find a cost-effective and uncomplicated way of relieving chronic pain of brittle bones.

Harvard scientists Kathryn Hall, Joseph Loscalzo, and Ted Kaptchuk believe that there may be a "placebome," a complex of genes related to the placebo effect, that explains why some people benefit from unlikely treatments and other people do not. It's in their genes. A placebo treatment may really, really work or not work at all. You won't know until you try it.

  • Guo T, Chen X, Wu X, Shan E, Jin Y, Tai X, Liu Z, Zhu B, Yuan K, Chen Z. Acupuncture for osteoporosis: a systematic review protocol. Syst Rev. 2016 Sep 21, 5(1):161. PMID: 27653783
  • Hall KT, Loscalzo J, Kaptchuk TJ. Genetics and the placebo effect: the placebome. Trends Mol Med. 2015 May
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  • Xie Y-m, Yuwen Y, Dong F-h, S-c S, Wang H-m, Q-s L, Z-j H, Ma L-x, Liao X, Xu G-q, et al. Clinical practice guideline of traditional medicine for primary osteoporosis. Chin J Integr Med. 2011.
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  • Yuan LM, Li YM, Chen LM, Lei XH & Jia SJ. (2015). Therapeutic Effect on Primary Osteoporosis Treated by Electro-acupuncture Combined with Jiawei Shentong Zhuyu Decoction. Journal of Clinical Acupuncture and Moxibustion. 31(8).
  • Zheng X, Wu G, Nie Y, Lin Y. Electroacupuncture at the governor vessel and bladder meridian acupoints improves postmenopausal osteoporosis through osteoprotegerin/RANKL/RANK and Wnt/β‑catenin signaling pathways. Exp Ther Med. 2015.10(2):541–8.
  • Photo courtesy of SteadyHealth

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