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Evidence-Based Complementary and Alternative Medicine
Volume 2011 (2011), Article ID 180805, 11 pages
http://dx.doi.org/10.1155/2011/180805
Review Article

Paradoxes in Acupuncture Research: Strategies for Moving Forward

1Department of Neurology, University of Vermont, Burlington, VT 05405, USA
2Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School, Boston, MA 02215-3326, USA
3Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
4College of Pharmacy, University of Texas, Austin, TX 78712-0127, USA
5Department of Research, Oregon College of Oriental Medicine, Portland, OR 97216-2859, USA
6Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA 02129-2020, USA
7Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD 21207-6697, USA
8Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC 27599-7200, USA
9Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48106, USA
10Chicken Soup Chinese Medicine, San Francisco, CA 94103-2961, USA
11Center for Health Studies, Group Health Cooperative, Seattle, WA 98101-1448, USA
12Department of Physiology and Biophysics, Georgetown University Medical Center, Washington, DC 20057-1460, USA

Received 5 April 2010; Revised 19 July 2010; Accepted 31 August 2010

Copyright © 2011 Helene M. Langevin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

In November 2007, the Society for Acupuncture Research (SAR) held an international symposium to mark the 10th anniversary of the 1997 NIH Consensus Development Conference on Acupuncture. The symposium presentations revealed the considerable maturation of the field of acupuncture research, yet two provocative paradoxes emerged. First, a number of well-designed clinical trials have reported that true acupuncture is superior to usual care, but does not significantly outperform sham acupuncture, findings apparently at odds with traditional theories regarding acupuncture point specificity. Second, although many studies using animal and human experimental models have reported physiological effects that vary as a function of needling parameters (e.g., mode of stimulation) the extent to which these parameters influence therapeutic outcomes in clinical trials is unclear. This White Paper, collaboratively written by the SAR Board of Directors, identifies gaps in knowledge underlying the paradoxes and proposes strategies for their resolution through translational research. We recommend that acupuncture treatments should be studied (1) “top down” as multi-component “whole-system” interventions and (2) “bottom up” as mechanistic studies that focus on understanding how individual treatment components interact and translate into clinical and physiological outcomes. Such a strategy, incorporating considerations of efficacy, effectiveness and qualitative measures, will strengthen the evidence base for such complex interventions as acupuncture.