During her third year of medical school, Liza was diagnosed with rheumatoid arthritis. She entered her family practice residency in a wheelchair.
"I was taking 13 different drugs, which gave me high blood pressure," she recalls. "I experienced severe pain every day, and I thought I'd have to give up being a doctor."
"I had treatments twice a week, with needles sticking out all over my arms and legs. The pain was much less, and the effect lasted for about two weeks," says Liza.
Acupuncture uses hair-thin needles to stimulate specific points on the patient's body. "We often combine acupuncture with Chinese herbal medicine, diet, and tai chi, says Ian A. Cyrus, RAc, DiplAc, president of the American Association of Oriental Medicine in Catasauqua, Penn.
"The underlying principle is that chi, our natural energy, flows through the body in well-defined pathways or channels, and acupuncture can balance this flow of energy," says Cyrus, who practices oriental medicine at the Center for Integrative Medicine at Thomas Jefferson University Hospital in Philadelphia. "Tai chi is a series of traditional exercises designed to similarly balance and regulate the flow of chi."
While western science isn't certain how tai chi and acupuncture actually work, evidence is accumulating that they do help patients with arthritis and other forms of chronic pain. The World Health Organization has concluded it may be helpful for several conditions including osteoarthritis, headache, gastritis, bronchitis, and low back pain. And an influential consensus conference convened by the National Institutes of Health in 1997 reported that acupuncture might be useful as an adjunct treatment for many forms of chronic pain.
"We think acupuncture does relieve arthritis pain," says Robert Spiera, MD, who specializes in rheumatology and arthritis at Beth Israel Medical Center in New York City. "While there aren't as many studies as we'd like, there have been studies showing benefit specifically in osteoarthritis of the knee. I've supported my patients in their decision to try acupuncture in addition to routine medical care and physical therapy."
"In my experience, acupuncture has generally been helpful for osteoarthritis. There is some controversy about how it works, but it's certainly a reasonable thing to try," says Judith Peterson, MD, a trained acupuncturist. "I try to do what offers the best result for the patient. For arthritis that might mean a combination of exercise, medicine, adapting the environment, and acupuncture." Peterson, who specializes in physical medicine and rehabilitation, is a clinical assistant professor at Thomas Jefferson University Hospital in Philadelphia.
"Tai chi for arthritis appears to make sense from many perspectives" says Spiera. "It is a gentle form of exercise, and we know that in arthritis, anything that improves people's mobility is good for their musculoskeletal health. Some of my patients feel it has really helped them."
In one small study, eight people with chronic arthritis pain, between 68 and 87 years old, participated in 10 weekly tai chi sessions, while another group of eight people carried out their usual activities. The people who took the tai chi classes reported their level of pain decreased significantly, while pain levels in the other group increased.
"Because tai chi combines meditation with slow, circular motions, it's an ideal exercise for elderly people, says Patricia Adler, MSN, RN, lead author of the study.
In this study, "People were encouraged to practice daily but not worry about remembering or practicing all the movements," Adler says. "Many of them said they felt more relaxed and energized after the class."
Oriental medicine is based on a principle called energetics, Cyrus says. "The premise is that chi is an underlying force which supports anatomical and physiological functioning. By balancing chi you promote health and well-being. We do not treat a specific biomedical complaint, we reframe that complaint as patterns of disharmony in the energetic system."
Peterson, a physician who is also an acupuncturist, uses very different words to explain how it may work.
"This is a powerful and elegant modality," she says. "Studies have shown that acupuncture needles stimulate sensory nerves, which send signals to the spinal cord, resulting in the release of [chemicals called] endorphins, which are natural pain-blockers. One animal study found acupuncture increased blood cortisol levels. Since cortisols are natural steroids, acupuncture may have a generalized anti-inflammatory effect, thus reducing pain from arthritis."
But however acupuncture works, there are so many stories suggesting it's helpful that people who haven't gotten relief from conventional medicine are understandably tempted to give it a try.
If you do try acupuncture, you shouldn't expect to feel better the moment you have your first treatment. It sometimes works more slowly than a medicine like aspirin or ibuprofen, Peterson says, but may have a longer effect. "Patients often start out with a course of 4-10 treatments, and usually experience benefit after the first several treatments," she says.
"There is a cumulative effect, depending on the degree of dysfunction," agrees Cyrus. "In my experience, diet is also very important. People with acute arthritis should avoid highly acidic foods and the nightshade family of plants, which includes tomatoes, potatoes, eggplants, and peppers."
Many states license acupuncturists, usually after they pass a national certification exam. To find an acupuncturist with broad training in oriental medicine, consult the American Association of Oriental Medicine in Catasauqua, Penn. To find a physician who is trained in acupuncture, consult the American Academy of Medical Acupuncture in Los Angeles.