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Defining an Adequate Dose of Acupuncture

Recently, a paper was published discussing ‘proper dosing’ of acupuncture. As identified in the paper, similarly to medications, the dosage of acupuncture makes a big difference in the treatment outcomes. In the paper, the authors recognize there are many contributing components to achieving optimal results, of which, “the ‘core’ components of an adequate protocol seem to be attention to: the number of needles used; the needling technique; specific elicitation of a needling sensation; the number of treatment sessions; and the experience of the acupuncturist” (White et al., 2008).


Although some of these factors are outside of the patient’s control, including the number of needles used and the technique for example, patients can give feedback regarding whether they feel something when acupuncture is applied, and the patient ultimately decides if they will commit to the number of treatment sessions recommended.


When a patient establishes care with a new acupuncturist, it is not uncommon for the acupuncturist to provide the patient with a treatment plan.  A treatment plan lays out the expected course of care to achieve the goals set forth by the patient. A good example of this interaction follows: 


Patient has had chronic back pain for several years. They establish care with Dr. Tank. After reviewing their intake, Dr. Tank asks what their goals for treatment are.  The patient responds they want to reduce their daily pain from 6-7/10 (10=worst) to 3-4/10 (10=worst). Dr. Tank suggests 3 appointments per week for two weeks. After two weeks, a re-assessment is done to determine how well the patient responds to the acupuncture. If acupuncture seems to be helping to reduce the pain, a new treatment plan is established which may be 1 appointment weekly for four weeks followed by another re-assessment to determine that the pain is, in fact, being kept at bay.  If all goes according to plan, the treatment plan might be modified to once every other week or once per month. 


Often, patients decide they want to come in at their will for treatments: perhaps they have responsibilities to their family or work and are not able to break away 2-3 times per week for the first two to three weeks; perhaps their insurance only allows a total of 12 appointments per year and they want to ‘space them out,’ perhaps they are not able to prioritize their health more than simply seeking an appointment now and again. Sadly, this can result in patients feeling like the ‘acupuncture is not working’ or that ‘acupuncture works for a little while, but it can’t help me to recover.’  And sometimes, the patients forget to ‘do their homework’ such as dietary modifications, taking their Chinese herbal formulas as prescribed, breath and stretching exercises, or other lifestyle adjustments suggested by the acupuncturist. It is important to stress that as an acupuncturist, “I only see you for an hour or two a week, at best. You have to do your homework the rest of the time to maintain the treatment effects.”


Many folks are aware they must take their prescribed antibiotics on time and that they must see the full course of antibiotics to the end to rid their body of the infection for which the antibiotics were prescribed. If they do not follow through, they risk the bacteria becoming stronger as a result of being exposed to the antibiotics, but not fully killing them off, and their infection may come back much worse than it began—or in a worst-case scenario, they may develop an antibiotic resistant infection such as MRSA.  This highlights treatment plan follow-through and dose dependency. While these dire straits are not expected by going off the prescribed course of acupuncture treatment, it is not uncommon for a patient to report their pain is unremitting or worsened when they do not follow the treatment plan. If there is one thing to be learned from this review, it is that the treatment plan exists to achieve the best outcomes for the patient and that acupuncture dosage is a key factor for whether those outcomes can realistically be achieved. 


White, A., Cummings, M., Barlas, P., Cardini, F., Filshie, J., Foster, N. E., … Witt, C. (2008). Defining an adequate dose of acupuncture using a neurophysiological approach - A narrative review of the literature. Acupuncture in Medicine, 26(2), 111–120.


Article Review By Dr. Crystal Rose Tank


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