Objective.— To provide clinicians, patients, and the general public with a responsible
assessment of the use and effectiveness of acupuncture to treat a variety
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 212 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,
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.