Acupuncture in America

I am in agreement with Belgrade's conclusions "that acupuncture be accepted by the American Pain Society as one of the many widely used stimulation-based therapeutic modalit ies" and "that an effort be made to educate our membership in order to minimize cultural bias, promote awareness, and foster large scale cooperative research." However, given the complexity of the problems and the extent of the controversy I would like to marshal more of the strong evidence in favor of acupuncture for treating chronic pain. I feel that Belgrade's article was weak in two major areas: the acupuncture endorphin mechanism and randomized clinical trials. While he touched on some of the papers supporting the acupuncture endorphin hypothesis, I feel that he did not do it justice. This is not the place for me to cover this huge body of research but I will give a much broader list of examples than he did. ~2,~4,~5 On the matter of randomized clinical trials, to test efficacy of acupuncture for chronic pain, he also gives too few examples of the enormous literature. ~5 But more egregiously, he does not mention a basic problem plaguing clinical research on acupuncture: the failure of the majority of papers to report the intensity of treatment given (i.e., very few clinical papers refer to the Deqi sensation elicited by high-intensity stimulation, considered so important for the activation of type III muscle afferents that activate the endorphin system). This error is analogous to concluding that a new drug has no effectiveness while testing it at one-tenth of its recommended dose. I will thus expand on two topics: the need to include many more papers to support the endorphin