The entrance to the pain clinic in Münster was in the courtyard, hidden between lush planting. A few years ago, my first appointment for the acupuncture consultation took place on a sunny spring day. Admittedly, I was skeptical whether needles would help me. But like every day of the four weeks ahead, I also plagued severe headaches and nausea this morning. So I didn't want to leave anything untidy.
"What brings you to us?", the doctor asked after I had taken a seat in the treatment room. Since adolescence, I have been living with migraines. Every two to three weeks, a seizure tears me out of everyday life, sometimes more, sometimes less. Fortunately, with the active ingredient group of triptans, there are medications with which I can control the seizures well and did so – until I found out that I was pregnant with my first child. Although Sumatriptan is considered relatively safe for the unborn child, I was unsettled. After consulting with my family doctor, I decided to sit out the migraine attacks with harmless painkillers – unfortunately without success.
After numerous doctor visits (family doctor, neurologist, gynecologist), I found myself in practice that specialized in pain therapy. The doctor patiently listened to my story, made notes, asked. Then he confirmed what other doctors had said before: I should at least try it out with acupuncture. Twice a week, five weeks, stainless steel needles in my body should relieve the pain. I stayed there for the first treatment.
Acupuncture should activate the body's own healing mechanisms.
As I tried to relax on the treatment bed, he pushed up to ten flexible single -knobs under my skin into the tissue below. They stayed up to 30 minutes there. The fine tools are between 0.2 and 0.4 millimeters narrow and sanded at the top. Because they are so thin, the puncture hardly hurts. Some needles are coated with medical silicone so that they slide more easily through the tissue. Because depending on which effect is desired, the acupuncture needles, which are up to five centimeters long, are engraved several centimeters deep into the skin.
The basic idea of acupuncture comes from traditional Chinese medicine (TCM). The theory: If the vital energy Qi, also called chi, flows in the body in disordered ways, the person is feeling bad. The pricking with the needles is intended to release energetic blockages and thus mobilize self-healing powers. The approximately 360 acupuncture points are arranged like a string on a system of either 12 or 14 "energy pathways", the meridians (see "The Meridians"). The pathways and points are named after the organs with which they are associated. Accordingly, there are, for example, the colon meridians arranged in a mirror image, as well as corresponding acupuncture points - in each case on the left and right halves of the body – colon 1, 2, 3 and so on.
Acupuncture over time
Already about 3000 years ago – in the Shang Dynasty - Chinese healers are said to have used needles to bring people back into mental and physical harmony. In the 1970s, acupuncture also reached the Western world. Over time, the repertoire has been expanded to include various methods: whether laser light or stimulation current, additional heat or even injections – traditional needle acupuncture has adapted to modern medicine. Laser acupuncture is considered a supplement to classical acupuncture and is especially interesting for people with a fear of needles. She works with light stimuli instead of mechanical ones. However, most of these new applications are incompatible with traditional acupuncture, and their benefits have also not been scientifically proven.
Which needles the treating uses, how deep and in what angle it puts it depends on various factors: short, only 15 millimeter long needles are often used on the face, while body needles with a length of more than four centimeters on legs or arms be set. There is more fat and muscle mass there than on the skull. The acupunctor treated my migraine pain by stabbing the neck, ears, wrists and feet. He turned the needle until he felt a resistance. I noticed how the places tingled and warm. Other patients report severity or deafness. These sensations are considered to be a sign that the needle sits correctly. A slight redness at the puncture site should also signal that the body reacts. So the blood circulation is stimulated locally.
It is unclear how many people undergo acupuncture regularly. After all, not only doctors are allowed to put needles after an appropriate further training, but also alternative practitioners, for example. According to a representative survey commissioned by "Apotheken Umschau" in 2019, one in five women and one in ten men in Germany have already used the TCM procedure. The alternative healing method is repeatedly discussed controversially. Even people who research acupuncture and use it themselves say that the exact mechanism of action is unclear.
A dilemma is the non -manifestable of the method. So far, scientists have not been able to prove, for example, that there is something like energy railways in the human body. Siegfried Mense is a functional neuroanatom. Until his emeritus worked and taught at the University of Heidelberg ten years ago. In the meantime, he researches mechanisms of muscle pain at the University of Mannheim. When asked how acupuncture can be explained physiologically, he said briefly: "Not at all." The system from meridians and acupuncture points cannot be located in the body. An argument by the supporters is that you could not see energy channels. Nevertheless, Mense. There is no suitable anatomical principle: "Nerve tracts, lymphatic paths, vascular tracks, i.e. veins and arteries - none of these systems runs in any way like the hypothetical meridians."
The neuroan atom also criticizes the modern interpretation of the healing process. "In the West, acupuncture is usually used as pain -relieving, that is, analgesic treatment," he explains. It is originally a natural philosophical concept to treat functional disorders, such as digestive or sleep problems. The focus of pain or various organic diseases is put on acupuncture a scientific-medical stamp that contradicts the traditional sense.
"If there is a prospect of improvement, there are at least well-reported clinical observations, no better suitable therapy is withheld from patients and it is repeatedly evaluated whether a treatment is effective, then acupuncture has a justification in evidence-based medicine," says Johannes Fleckenstein. The physician heads the special sports medicine pain therapy at the Goethe University Frankfurt and is also deputy head of the Science Center of the German Medical Society for Acupuncture (DÄGfA).
Since 2007, statutory health insurance companies have been taking on acupuncture for chronic pain in the lede spine and the knee joint for up to ten sessions within six weeks. In the meantime, treatments are also paid that go beyond the classic diagnoses - i.e. cross pain and knee arthrosis. On a voluntary basis, the health insurers cover, for example, applications for pregnancy and birth preparation. This can include: therapy of pregnancy and vomiting as well as back and coccyx pain. Or - as in my case - chronic pain diseases such as migraines.
The basis for these decisions were extensive clinical trials with names such as German Acupuncture Trials (GERAC), Acupuncture in Routine Care (ARC) and Acupuncture Randomised Trials (ART) – funded by consortia of German health insurance companies. The focus was on chronic pain of various causes, in addition to the previously mentioned, for example, tension- and migraine-related headaches. More than 300,000 people with various underlying diseases and pain took part in the ART and ARC studies alone.
To find out whether acupuncture helps them, the participants were randomly divided into different groups: one received acupuncture, while another remained untreated. Such a study design is called randomized controlled study. However, there was another group that was subjected to a bogus treatment, sometimes also called minimal acupuncture. Instead of stinging deeply and at classic acupuncture points, the needles are only placed superficial and off these places. The patients did not know which of the groups they belonged to.
For all three diagnoses examined- knee, head and back pain- the acupuncture group showed an improvement in symptoms to those who had not received treatment. However, neither with the headaches nor the back pain made it a difference whether it was stung at any number of points or at acupuncture points. Only with the knee osteoarthritis resulted in a minimal advantage of acupuncture compared to the sham treatment. The effect of the needles is nothing more than a placebo effect, critics of the procedure say.
This argument does not apply to Stefanie Joos. The medical director of the Institute of General Medicine and Interprofessional Care at the University Hospital Tübingen conducts research on acupuncture and offers it for various ailments. "Inserting a needle anywhere on the body can stimulate local blood flow, enhance local immune responses, and trigger analgesic responses." In this context, it is wrong to speak of "placebo" in this context. According to Joos, a distinction must be made between pure placebos and those that she describes as active placebos. "The latter result in more or less desirable reactions in the body, which cannot be accurately estimated in their extent and direction of action, " says the doctor. This is the case with minimal acupuncture, when the skin is pierced at non-acupuncture points. So the needling triggers a reaction, but it is – in contrast to acupuncture - non-specific.
This is indeed a dilemma. Because in order to prevent faith over the effect of the study results, actual and sham treatment must feel completely the same. In the best case, neither the subjects nor the treated know whether it is the real or the control condition. This is impossible for acupuncture, because at least the doctor knows whether the needles hit the acupuncture points. In this way, they can influence the condition of the patient.
However, the lack of control is not the only problem. There is no shortage of clinical studies. In the past 20 years alone, more than 28,000 reports have been published, and there are meta -analyzes - i.e. summaries of many individual studies - that describe positive acupuncture effects. However, an analysis from 2019 of almost 180 reviews and meta studies showed that the majority of research on acupuncture had defects in the methodology or statistical evaluation. For example, too few subjects took part. In short: There is an inadequate number of studies of high quality to demonstrate a positive effect in chronic pain.
Now it would be possible to plan studies on a large scale or, if necessary, to repeat them with more participants. But, doctor Joos points out, "for confirmatory studies, researchers need a budget of up to one million euros". She had submitted several applications for large acupuncture studies to the Federal Ministry of Education and Research (BMBF), but they had never been approved. "This is unfortunate and shows once again that research in Germany has significant disadvantages for such large-scale studies compared to other countries such as the USA, Canada and Australia.«
Despite the paucity of evidence, of great importance
In order to close the knowledge gaps regarding alternative healing procedures, the World Health Organization (WHO) wants to establish a global center for traditional medicine in India. Acupuncture, Ayurveda and other practices are to be examined with modern methods. The WHO wants to set standards. To carry out good clinical studies on the topic and to check the procedures for plausibility seems sensible, Georg Rüschemeyer told the German Press Agency. He is a scientific author at Cochrane Collaboration, an international research network, known for his systematic reviews on medical questions. There are several cochrane reviews on alternative medicine such as acupuncture. But: "I have not yet come across many who showed really convincing evidence for a traditional process," he says.
Despite all the uncertainties in the study situation and the still missing mechanism of action, the TCM procedure has long been found in various medical guidelines, for example on non-specific low back pain or for the treatment of mild to moderate Crohn's disease flare-ups. "If you look at current guidelines, acupuncture is becoming increasingly important there," says Johannes Fleckenstein. In the past, it was offered individually, especially in practices, but today it is part of therapy concepts in hospitals and university clinics.
Acupuncture is considered an invasive but low -side effect. Occasionally there is bleeding and pain at the puncture sites or the wounds ignite. Dizziness and fainting are also possible. Serious consequences such as organ or tissue damage are very rare. Then the lungs or the central nervous system are usually affected. In order to keep the risk of undesirable side effects low, it is worth taking a closer look at the qualifications of the acupuncture. According to the specifications of the medical association of the respective federal state, doctors complete several basic courses with extensive practical exercises and other practical courses for the additional training »acupuncture«. You not only have to learn acupuncture points and meridians, but also more about pain therapy and psychosomatics. At least 200 teaching units must be on the certificate at the end of several years of further training so that needles can be officially set. Also alternative practitioners can qualify accordingly, but in contrast to doctors, the services are not settled with the health insurance company.
But there are also providers who convey TCM knowledge in pure online courses. Participants then also receive a final certificate without ever putting a needle under professional supervision. Black sheep like this needs to be avoided. "From the Dägfa's point of view, acupuncture is a medically indicated and executed therapy," says sports doctor Fleckenstein. Risks and side effects belonged before treatment for the first time as with other therapies. He advises: "Acupuncture should only be used by practiced hands."
Experienced hands like those of the specialist for pain therapy, who stuck ten needles into my head, hands and feet week after week. The migraine, however, was not impressed. In retrospect, this is not surprising. It is now known that although acupuncture can – possibly – prevent migraine attacks, it cannot relieve them acutely. In my case, the symptoms even worsened under the treatments. In the end, I had no choice but to sit out the attack, which lasted for several weeks at that time – until about the 15th week of pregnancy. Then the migraine spook was suddenly over. Whether with or without acupuncture, this cannot be answered conclusively.
