ACUPUNCTURE

Objective.-To provide clinicians, patients, and the general public wit h a responsible assessment of the use and effectiveness of acupuncture to treat a variety of conditions. Participants.-A nonfederal, nonadvo cate, 12-member panel representing the fields of acupuncture, pain, ps ychology, psychiatry, physical medicine and rehabilitation, drug abuse , family practice, internal medicine, health policy, epidemiology, sta tistics, 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 discussion s were divided into 3 phases over 2 1/2 days: (1) presentations by inv estigators 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 remainde r of the second day and morning of the third. The conference was organ ized and supported by the Office of Alternative Medicine and the Offic e 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 Med icine, EMBASE, and MANTIS, as well as through a hand search of 9 journ als that were not indexed by the National Library of Medicine. An exte nsive bibliography of 2302 references was provided to the panel and th e 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 expe rience. 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 dra ft statement, which was read in its entirety and circulated to the exp erts and the audience for comment. Thereafter, the panel resolved conf licting 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 Wo rld Wide Web immediately following its release at the conference and w as updated with the panel's final revisions within a few weeks of the conference. The statement is available at http://consensus.nih.gov. Co nclusions.-Acupuncture as a therapeutic intervention is widely practic ed 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 furthe r complicated by inherent difficulties in the use of appropriate contr ols, 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 postop erative dental pain. There are other situations, such as addiction, st roke rehabilitation, headache, menstrual cramps, tennis elbow, fibromy algia, myofascial pain, osteoarthritis, low back pain, carpal tunnel s yndrome, and asthma, in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensi ve management program. Further research is likely to uncover additiona l areas where acupuncture interventions will be useful.