OBJECTIVE: To provide clinicians, patients, and the general public
with a responsible assessment of the use and effectiveness of
acupuncture to treat a variety of conditions.
PARTICIPANTS: A nonfederal, nonadvocate, 12-member panel
representing the fields of acupuncture, pain, psychology, psychiatry,
physical medicine and rehabilitation, drug abuse, family practice,
internal medicine, health policy, epidemiology, statistics,
physiology, biophysics, and the representatives of the public.
In addition, 25 experts from these same fields presented data
to the panel and a conference audience of 1200. Presentations
and discussions were divided into 3 phases over 2 1/2 days:
(1) presentations by investigators working in areas relevant
to the consensus questions during a 2-day public session; (2)
questions and statements from conference attendees during open
discussion periods that were part of the public session; and
(3) closed deliberations by the panel during the remainder of
the second day and morning of the third. The conference was
organized and supported by the Office of Alternative Medicine
and the Office of Medical Applications of Research, National
Institutes of Health, Bethesda, Md.
EVIDENCE: The literature, produced from January 1970 to October
1997, was searched through MEDLINE, Allied and Alternative
Medicine, EMBASE, and MANTIS, as well as through a hand search
of 9 journals that were not indexed by the National Library of Medicine.
An extensive bibliography of 2302 references was provided to the
panel and the conference audience. Expert speakers prepared
abstracts of their own conference presentations with relevant
citations from the literature. Scientific evidence was given
precedence over clinical anecdotal experience.
CONSENSUS PROCESS: The panel, answering predefined questions,
developed their conclusions based on the scientific evidence
presented in the open forum and scientific literature. The panel
composed a draft statement, which was read in its entirety and
circulated to the experts and the audience for comment.
Thereafter, the panel resolved conflicting recommendations and
released a revised statement at the end of the conference. The
panel finalized the revisions within a few weeks after the
conference. The draft statement was made available on the
World Wide Web immediately following its release at the
conference and was updated with the panel's final revisions
within a few weeks of the conference. The statement is
available at http://consensus.nih.gov.
CONCLUSIONS: Acupuncture as a therapeutic intervention is widely
practiced in the United States. Although 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.