Below is an article on the subject of Is Acupuncture a Valid Treatment in Veterinary Medicine? written by Dr. Huisheng Xie of the Chi Institute
Complementary and alternative medicine (CAM) have been used to treat many different diseases in animals.
Acupuncture is one of the most commonly used CAM treatments because of its long history and research-based evidence of effectiveness. Acupuncture has been used to treat animal diseases in China for more than 2,000 years.
The number of U.S. veterinarians who have practiced acupuncture has been estimated to be 4,300 or approximately 6% of all practicing veterinarians.
As the use of acupuncture becomes more common in veterinary practice, veterinary acupuncturists are commonly asked by their colleagues and the general public “Is acupuncture really effective?”
The following information provides some details about veterinary acupuncture that demonstrate the effectiveness, acceptance and quality of acupuncture as a treatment in veterinary practice to help answer this common question. The information is presented in five categories.
Scientific Research Supports Acupuncture as an Effective Treatment for a Variety of Medical DisordersThe U.S. National Library of Medicine can be searched through PubMed at: http://www.ncbi/. nlm.nih.gov/ pubmed/ and the increasing volume of scientific research that has now been performed on the basic mechanisms and clinical applications of acupuncture in both animals and humans can be appreciated. As of June 1, 2010, a database search using the keyword “acupuncture” and limited only to papers with ‘abstracts’, produced 15,181 papers on acupuncture published in English.. Among these research papers, 282 articles specifically relate to veterinary medicine, and provide evidence to validate Chinese acupuncture theories and effectiveness. Furthermore, they support the use of acupuncture as a safe and effective treatment for many disorders in animals.
In 1997 the National Institutes of Health (NIH) published a consensus paper on acupuncture.
This was the result of several days of expert scientific presentations and discussions by an independent group of professionals. They concluded: “Acupuncture, as a therapeutic intervention, is widely practiced in the United States. While there have been many studies of its potential usefulness, many of these studies provide equivocal results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebos and sham acupuncture groups. However, promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting, and in postoperative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis,low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful.”
The evidence for the efficacy of acupuncture treatment for many medical conditions has increased exponentially since that time and the consensus statement has not been updated; therefore, the NIH refers readers to their source of updated health information from the NIH National Center for Complementary and Alternative Medicine, which has an updated overview of the use of acupuncture for human disease.6 In 2003, the World Health Organization (WHO) published a review of the scientific evidence for acupuncture treatment of various medical conditions. After analysis of the clinical trials of acupuncture, the WHO concluded that acupuncture had significant therapeutic effects for a large number of human medical disorders. The WHO report listed 28 symptoms, diseases and conditions for which acupuncture has “…been proved - through controlled trials - to be an effective treatment,” including but not limited to numerous types of pain, allergic rhinitis, nausea and vomiting, and elevated and decreased blood pressure. The review also listed an additional 63 conditions for which, “The therapeutic effect of acupuncture has been shown, but for which further proof is needed.”
The NIH and WHO are not the only professional, independent medical experts that have analyzed and concluded that acupuncture is an effective and valid treatment. In 2007, the American Pain Society and the American College of Physicians issued joint clinical practice guidelines for diagnosis and treatment of low back pain. These stated that, “For patients who do not improve with self-care options, clinicians should consider the addition of non-pharmacologic therapy with proven benefits,” and went on to recommend acupuncture for low back pain especially when pain is subacute or chronic.
These findings, by well respected, objective professional organizations, demonstrate how far the integration of acupuncture as a standard of care has come from its earliest beginnings. In recent years, a large amount of data has accumulated not only to support the clinical relevance and effectiveness of acupuncture, but also to provide insights into the basic mechanisms of actions of acupuncture and validate Traditional Chinese Medical (TCM) theories.
In TCM theory, acupuncture points are associated with specific internal organs and bodily functions. Functional magnetic resonance imaging (fMRI )and positron emission tomography (PET) studies have been used to demonstrate the direct relationship between acupuncture point stimulation and activation of brain areas related to a specific organ or function as described by TCM theory. For example, the acupuncture point ST-36 (the 36th point on the Stomach Channel) is suggested in TCM theory to effect the stomach. When ST-36 was stimulated with an acupuncture needle, increased activity in the regions of the brain associated with gastric function was observed on PET scans, thus supporting TCMtheory that specific acupuncture points are related to specific organs.
There have been several other studies of ST-36 utilizing PET scans and fMRI. Stimulation of the acupuncture point PC-6 (the 6th point of the Pericardium Channel) is known in TCM to control nausea and vomiting. Evaluation of fMRI during PC-6 stimulation, showed activation of brain regions affecting gastric myoelectrical activity, vagal modulation and cerebellar vestibular activity, all of which are involved in nausea and vomiting thus supporting the TCM theory that specific acupuncture points have specific actions.
Another study utilizing MRI, evaluated the accuracy of TCM theory regarding the internal organs associated with each acupuncture Channel. An MRI contrast agent was injected into various acupuncture points and the migration of the contrast was monitored by MRI. The final distribution of the contrast agent was found to correspond to the internal organ with which the injected acupuncture point is associated in TCM theory.
A variety of research studies have confirmed the efficacy of acupuncture in veterinary medicine. Fifty dogs with thoracolumbar intervertebral disk disease were randomly allocated to one of two treatment groups and classified as having grade 1-5 (grade 1 = mild and grade 5 = severe) neurologic dysfunction. Dogs in group one received electro-acupuncture stimulation combined with standard conventional medical treatment and those in group two received only standard conventional medical treatment. A numeric score for neurologic function was evaluated at four different time intervals to evaluate the effect of treatments. The time (mean ± SD) to recover ambulation in dogs with grade 3 and 4 dysfunction in group one (10.10 ± 6.49 days) was significantly less than in group two (20.83 ± 11.99 days). The success rate (ability to walk without assistance) for dogs with grade 3 and 4 dysfunction in group one (10/10 dogs) was significantly higher than that ofsimilarly affected dogs in group two (6/9 dogs). The overall success rate (all dysfunction grades) for group one was significantly higher (23/26; 88.5%) than for group two (14/24; 58.3%). The conclusion of the study was that electro-acupuncture combined with standard conventional medical treatment was not only effective, but resulted in a shorter time to recover ambulation and deep pain perception, than did the use of conventional treatment alone in dogs with thoracolumbar intervertebral disk disease.
Dr. Joaquim and his colleagues conducted a similar and further study. Forty dogs with severe neurologic signs to thoracolumbar IVDD were divided into three treatment groups: decompressive surgery (DSX), electroacupuncture (EAP), and DSX followed by EAP (DSX + EAP). Neurologic signs were assessed by use of a scale ranging from 1 (least severe) to 5 (most severe). Ten dogs underwent DSX, dogs received EAP alone and 11 dogs underwent DSX + EAP. Aclinical success was considered when a dog initially classified as grade 4 or 5 was classified as grade 1 or 2 within 6 months after the end of treatment. The researchers found that that the proportion of dogs with clinical success was significantly higher for dogs that underwent EAP (15/19) than for dogs that underwent DSX (4/10); the proportion of dogs with clinical success for dogs that underwent DSX + EAP was intermediate (8/11). Thus, they concluded that EAP was more effective than DSX for recovery of ambulation and improvement in neurologic deficits in dogs with long-standing severe deficits attributable to thoracolumbar IVDD.
Another example of the use of acupuncture in veterinary medicine is in equine reproduction. Research findings support the use of acupuncture as a treatment in equine reproductive disorders including anestrus, urine pooling, infertility, and poor libido in stallions. 14 The mechanisms of the therapeutic effects of acupuncture are associated with hormonal regulation, altered smooth muscle motility, and general stress and/or pain relief from musculoskeletal or environmental conditions.
Acupuncture is Part of the Curriculum of DVM Programs at AVMA Accredited Veterinary Medical SchoolsAn elective two-week Acupuncture Clinical Rotation (VEM 5876) has been offered annually at the University of Florida, College of Veterinary Medicine (UFCVM) since 2001. Approximately sixty junior and senior veterinary students elect to take this clinical rotation annually. Eight interns have completed the Acupuncture Internship Program at UFCVM since 2004. The UFCVM Acupuncture Service treats patients Monday through Saturday with an average weekly caseload of 30 to 50 animals. The patients are primarily in-house referrals from other services and outside referrals from other veterinarians. Patients are most frequently treated for oncological, dermatologic, neurologic, endocrine, renal, musculoskeletal, gastrointestinal, respiratory, cardiovascular, or behavioral problems. Acupuncture is part of the curriculum of the DVM programs at other .AVMA-accredited veterinary schools as well. The AVMA-accredited veterinary medical schools which teach some aspect of acupuncture include: University of California, Davis; University of Tennessee; Washington State University; Oklahoma State University; Murdoch University; and University of Minnesota. NIH Grants and other Funding Sources Encourage and Support Research on Acupuncture The National Center for Complementary and Alternative Medicine (NCCAM) is one of the 27 institutes and centers that make up the National Institutes of Health (NIH). NCCAM received approximately $31 million from the American Recovery and Reinvestment Act (Recovery Act) to fund complementary and alternative medicine research in fiscal years 2009 and 2010. As of September 30, 2009, NCCAM had awarded $16.8 million to fund 45 new and pending grant applications. Of this amount, $2.48 million was allocated to projects specifically dedicated to the study of the mechanisms of action of acupuncture and the efficacy of acupuncture treatment in a variety of medical disorders. In addition, the NIH Office of the Director funded four grants for a total of $1.4 million that NCCAM will administer. Studies on chronic pain one of the main targets of Recovery Act funding, are “A vital component of NCCAM's research portfolio,” and acupuncture actions and efficacy are akey part of chronic pain research.
Other funding sources currently supporting acupuncture research include the Florida Pari-Mutual, Morris Animal Foundation (MAF) and the American Association of Equine Practitioners (AAEP). Over the past ten years, as a member of the faculty of the UFCVM, the author (Huisheng Xie) has been the Principal Investigator (PI) or Co-PI of seven funded research studies of the efficacy and mechanisms of action of acupuncture in horses and dogs. Acupuncture research supported by grants from UFCVM have included scientific studies of acupuncture treatment of chronic thoracolumbar pain in horses, the effects of acupuncture on pulmonary function in horses, the ability of acupuncture to decrease intraocular pressure in Rhesus monkeys with chronic glaucoma, the efficacy of acupuncture on experimentally induced colic in horses, the assessment of qualify of life after acupuncture treatment in dogs and cats and the influence and mechanisms of action of acupuncture stimulation on pain thresholds in horses. Results of UFCVM acupuncture research have been instrumental not only to evaluate the effects of acupuncture but to develop techniques to achieve the greatest therapeutic effect. For example, it was found in one study that electro-acupuncture (EA) treatments using high frequencies (80-120 Hz) induced a stronger local analgesic effect than EA treatments using low frequencies (20 Hz).
However, EA treatments with lower frequencies induced analgesia that, although milder in its effect, persisted longer. This study not only proved that EA has clinically useful analgesic effects, but also demonstrated how EA can be best applied in clinical practice. It has been found from research at UFCVM that hoof withdrawal reflex latency (HWRL) can be a valid measurement to assess pain perception and the degree of pain relief achieved with acupuncture in horses. In one study, EA significantly increased HWRL and reduced the lameness score, while simultaneously increasing the plasma β-endorphin concentration.16 Based on these results, the release of β-endorphin is thought to be one of the pathways through which acupuncture relieves pain. None of the acupuncture treatments altered the ACTH concentrations, which suggests that ACTH is not involved in EA analgesia.
Clinical trials using EA were conducted in performance horses suffering from chronic back pain.18,19 Results provided evidence that three sessions of EA treatment successfully relieved signs of back pain in horses and that the analgesic effect induced by EA lasted at least 2 weeks. In one study, oral medication with phenylbutazone did not effectively relieve the signs of back pain.
Another example of clinically useful results from a UFCVM supported acupuncture pilot research project involved the study of the efficacy of EA in Rhesus Monkeys with glaucoma20 . After one hour EA treatment, the intraocular pressure (IOP) decreased to less than half the baseline pressure (41.1±8.3 versus. 20.9±3.3 mmHg±SD, p<0.05). The IOP remained considerably decreased at 24 hours (26.6±9.3 mmHg) and 48 hours (27.9±3.8 mmHg), but was not significantly different at 72 hours (32.6±7.1 mmHg) after treatment. The IOP in the control group did not differ from baseline values. As glaucoma is the leading cause of irreversible blindness in people, this pilot study may lead to National Institutes of Health (NIH) funding for a larger study to continue research on the efficacy of EA for glaucoma. Assessment and promotion of the quality of life in geriatric patients receiving acupuncture is another ongoing research project at UFCVM.
As the life span of companion animals increases, geriatric health care is becoming increasingly important in veterinary practice. The primary goal for many geriatric patients with chronic degenerative disease is to promote the quality of their lives and slow the progression of their disease rather than expect a cure. A life quality assessment scale was created to evaluate the quality of life and effects of acupuncture in geriatric patients and positive effects on life quality of dogs and cats receiving acupuncture have already been noted.21 The American Veterinary Medical Association Supports Continuing Education in Veterinary AcupunctureIn 1996, the AVMA, in their guidelines on alternative therapies, stated that, “Veterinary acupuncture and acutherapy are now considered an integral part of veterinary medicine,” and the annual AVMA conventions often include lectures on acupuncture.
The latest AVMA Guidelines for Complementary and Alternative Veterinary Medicine (approved in 2001, revised in 2007) simply state that, “Recommendations for effective and safe care should be based on available scientific knowledge,” and that, “Veterinarians should ensure that they have the requisite skills and knowledge for any treatment modality they may consider using.” Acupuncture Training is for Veterinarians only and Requires Intensive Study for CertificationAlthough specialization in veterinary acupuncture is not yet recognized by the AVMA American Board of Specialties, training and certification in veterinary acupuncture is available to veterinarians through three continuing education programs in the United States (U.S.). A typical acupuncture training program requires 130-140-hours of lectures and laboratories, with rigorous written and oral examinations, 30-40 hours of internship training with a certified acupuncturist and written case reports in order to receive a certified veterinary acupuncturist (CVA) certificate. The U.S. CVA program providers are the Chi Institute of Chinese Medicine (Chi Institute), the Colorado Veterinary Medical Association (CVMA) and the International Veterinary Acupuncture Society (IVAS) 24-26. The number of U.S. veterinarians who have taken a CVA course from one of these three programs has been conservatively estimated to be 4,300 or approximately 6% of all practicingveterinarians. 27 CVA veterinarians are well trained and highly qualified to practice veterinary acupuncture and can be found on the websites of the organizations that provide certification.
1. Kim MS, Yamate M. Complementary & alternative medicine in the veterinary field. FVMA ADVOCATE 2007; 8: 5-7.
2.Yu C. Traditional Chinese Veterinary Acupuncture and Moxibustion. Beijing, China: China Agricultural Press 1995:1-6. (In Chinese)
3. Chrisman CL, Xie H. Traditional Chinese veterinary medical education in colleges of veterinary medicine in the United States and China. Amer Jour of Trad Chinese Vet Med 2010; 5(2): 1-4.
.5.NIH consensus: http://consensus.nih.gov/1997/1997acupuncture107html.htm.
6.NIH trusted health information: http://www.nlm.nih.gov/medlineplus/.
7. World Health Organization. Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials 2003. http://apps/. who.int/medicine docs/en/d/ Js4926e/.
8. Chou R, Qaseem A, Snow V et al. Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine, October 2007; 147 (7) 478-491 begin_of_the_skype_highlighting 147 (7) 478-491 end_of_the_skype_highlighting.
9.Yin L, Jin X, Qiao W et al. PET imaging of brain function while puncturing the acupoint ST36, Chinese Med Jour 2003 ; 116 (12): 1836-9.
10.Streitberger K, Ezzo J, Schneider A. Acupuncture for nausea and vomiting: an update of clinical and experimental studies, Auton Neurosci 2006; 129(1-2): 107-17.
11. Kim J, Bae KH, Hong KS et al. Magnetic Resonance Imaging and Acupuncture: A Feasibility Study on the Migration of Tracers after Injection at Acupoints of Small Animals. Journal of Acupuncture and Meridian Studies 2009; 2(2): 152-158
.12.Hayashi AM, Matera JM, Fonseca Pinto AC. Evaluation of electroacupuncture treatment for thoracolumbar intervertebral disk disease in dogs. J Am Vet Med Assoc. 2007; 231(6):913- 8.
13. Joaquim JG, Luna SP, Brondani JT, Torelli SR, Rahal SC, de Paula Freitas F. Comparison of decompressive surgery, electroacupuncture, and decompressive surgery followed by electroacupuncture for the treatment of dogs with intervertebral disk disease with long-standing severe neurologic deficits. J Am Vet Med Assoc. 2010 Jun 1;236(11):1225-914. Schofield WA. Use of acupuncture in equine reproduction. Theriogenology 2008; 70(3):430- 4. Epub 2008 Jun 11.
15.NIH: National Center for Complementary and Alternative Medicine http://nccam/. nih.gov/recovery /. 16. Xie H, Ott EA, Harkins JD et al. Influence of electroacupuncture stimulation on pain threshold in horses and its mode of actions. Journal of Equine Veterinary Science 2001; 21(12): 591-600.
17.Xie H, Ott EA, Colahan P. The effectiveness of electro-acupuncture on experimental lameness in horses. Am Jour Trad Chinese Vet Med 2009; 4(2)17-29.
18. Xie H, Colahan PT, Ott EA. Evaluation of electroacupuncture treatment of horses with signs of chronic thoracolumbar pain. Jour of the Amer Vet MedAssoc 2005; 227 (2): 281-286.
19. Rungsri P, Trinarong C, Rojanasthien S, Xie H et al. The effectiveness electro-acupuncture on pain threshold in sport horses with back pain. Amer Jour Trad Chinese Vet Med 2009; 4(1) 22-26.
20. Cantwell SL, Brooks DE, Xie H, Sapp HL. Electro-acupuncture to decrease intraocular pressure in Rhesus monkeys with chronic glaucoma. Proceedings of the Association for Research in Vision and Ophthalmology (ARVO) Annual Conference, Fort Lauderdale, Florida 2007:48.
21. Xie H. How to evaluate and improve the quality of life. Proceedings of The North American Veterinary Conference: Small animal & Exotics. Orlando, Florida 2009:81-83.
22. American Veterinary Medical Association Guidelines on Alternative Therapies, Jour Amer Vet Med Assoc 1996; 209(6): 1027-102823 begin_of_the_skype_highlighting 1027-102823 end_of_the_skype_highlighting. AVMA Guidelines for Complementary and Alternative Veterinary Medicine http://www.avma.org/issues/policy/comp_alt_medicine.asp.
24. Chi Institute of Chinese Medicine. http://www.tcvm.com/.
25. Colorado Veterinary Medical Association meetings/education. http://www.colovma.com/.
26. International Veterinary Acupuncture Society. http://www.ivas.org/.