People with arthritis frequently use complementary and alternative therapies such as acupuncture, an ancient Chinese art that seeks to correct imbalances in the flow of energy by selecting appropriate acupuncture points for stimulation. Such stimulation often involves the puncturing of the skin with needles.

However, practitioners can also use needle manipulation, heat, pressure, suction, and electrical current to stimulate the chosen points. The concept of yin and yang is the most important theory in traditional Chinese medicine. It claims that all things have two aspects, yin and yang, that are at the same time both opposite and dependent on each other.

They are in a constant state of change and balance. Disease results from loss of this balance, and treatment is directed at restoring it. Qi is the life force that governs the functions of the organs and flows through meridians or channels to all parts of the body. Pain results from disturbances of this flow.

Several types of acupuncture practice may be found in the Western world:

• Traditional Chinese acupuncture is based on traditional diagnoses and aims at restoring yin and yang and normal qi flow.

• Cookbook acupuncture consists of techniques borrowed from Chinese acupuncture but used to treat disorders based on a Western medical diagnosis. An example is the commonly used auricular acupuncture to help with smoking cessation. A small but increasing number of Western medical practitioners are using this type of acupuncture as well as trigger point acupuncture.

• Trigger point acupuncture is used to relieve musculoskeletal pain. The trigger points so often found in FIBROMYALGIA have been scientifically studied in the West only in the past 70 years. As long ago as 600 B.C. the Chinese were inserting needles into these ah shi (ah yes) points.

• Scientific acupuncture is based on modern scientific interpretations of the physiological effects of traditional methods.

The insertion of the needles is not particularly painful. However, for maximum benefit a needling sensation should be felt. This is variously described as dull, aching, heavy, sore, distending, or warm, and it may travel away from the needle site.

Patients may feel relaxed afterward and can get quite drowsy and occasionally euphoric, presumably as a result of endorphin release. An average treatment involves five to 10 sessions, and most acupuncturists continue treatment until the patient is cured or no further improvement occurs. Determining if acupuncture is useful for the treatment of arthritis has been difficult.

Clinical trials examining the effectiveness of acupuncture for the treatment of rheumatological problems have been criticized because the number of patients studied was often small and because it was difficult to control for a placebo effect occurring in response to the needles.

Some studies have tried to overcome this criticism by using needles to stimulate sham or placebo points that should not result in benefits and then comparing these results with those of active acupuncture. There has, how however, been disagreement whether a nonacupuncture type of treatment or acupuncture at a sham point is the most appropriate control group.

There are few well-designed studies, and some have shown a small improvement in pain in patients with OSTEOARTHRITIS and fibromyalgia. Several trials have shown modest benefits in treating particularly troublesome joints in RHEUMATOID ARTHRITIS.

The risks from acupuncture are small, provided that needles are adequately sterilized and are not inserted into a nerve, vital organ, or artery. Puncture of the lung (pneumothorax), transmission of HEPATITIS B or HEPATITIS C, nerve damage, and bleeding are uncommon complications.