Can acupuncture help cardiac patients reduce chest pain?

Acupuncture is one of the oldest practices of traditional Chinese medicine, with its use dating to at least 100 BC. It has received begrudging acceptance by the medical community in this country as an adjunct to Western medical care, primarily in pain management.

A newly released study may win the practice more respect, as it utilizes rigorous scientific methods including randomization, careful patient selection, blinding, and a placebo group to show a significant improvement in the chest pain (angina) that cardiac patients experience.

All 404 patients in this study, conducted in five centers in China, received standard Western cardiac medications for their stable angina for four weeks before the trial started, and continued their medication for the entire 16-week study. They were divided into four groups: three groups received acupuncture and one did not. What was unique about this study was the placebo acupuncture group receiving needling, but not true acupuncture. A second group had acupuncture delivered to the meridian that traditional practitioners have used to treat heart disease, which is located along the inner arm. The third group received traditional acupuncture, but not directed to the heart meridian. The final group received no acupuncture, but continued to take their Western medication.

Participants in the three active treatment groups received 12 sessions of treatment lasting 30 minutes each. Licensed acupuncturists used disposable steel needles and electroacupunture (the needle was hooked up to a nerve stimulator) was used as it has been shown to relieve pain and prevent heart injury in other studies compared to manual acupuncture.

The results: The participants in the traditional acupuncture arm of the study had significantly fewer attacks of angina during the 16 weeks after randomization. During the month before treatment, the mean frequency of attacks was 13.3. This decreased to about 5 episodes per month in the traditional acupuncture group, 10 in the sham group, and 11 in the medicine group. Other measures such as quality of life and intensity of attacks also were significantly improved.

The hypothesis why it worked: Acupuncture seemed to help the autonomic nervous system by improving the balance between the vagus nerve and sympathetic nervous systems, and targeting to the specific area used in traditional acupuncture made a significant difference.

The bottom line: Acupuncture helped decrease angina when added to traditional Western medications.

There were three major imitations of this study: its small size; uncertainty about how long the effect of acupuncture will last — the groups received one month of treatment, although effects lasted, participants were only evaluated for a total 16 weeks — and that the population studied was relatively healthy, so the results are not applicable to those suffering intractable or severe angina.

Despite these limitations, this trial is important. Modern treatment for stable angina is far from perfect. Coronary stenting — the standard procedure to improve blood flow — although potentially lifesaving when done to prevent an impending heart attack, has come under increasing scrutiny for overuse in people with stable angina symptoms. The ORBITA trial, published in Lancet in 2017, showed no improvement compared to medications when coronary stenting was done for patients with stable angina.

Other very expensive treatments have been tried and discarded because they have not been shown to be effective. Several years ago, transmyocardial laser revascularization (TMR), which required burrowing small holes into the heart, looked like it might be an option for people with intractable angina. It was an expensive flop that did not help much more than a placebo.

When I spent time in mainland China in 1986, there was almost no interaction between traditional Chinese medicine and the blossoming Western medicine in that country, and little interest by U.S. physicians to integrate traditional medicine into their practices. One reason was the lack of good, controlled studies showing the positive effects of treatments such as acupuncture. Trials like this one show that Western treatment for heart disease can be successfully merged with an ancient Eastern disciple such as acupuncture to help improve cardiac care.

David Becker is a board-certified cardiologist with Chestnut Hill Temple Cardiology in Flourtown, Pa. He has been in practice for 25 years. He will address the issue of how writing has changed his approach to medicine at the Inquirer’s “Telling Your Health Story” event on Sept. 28. For tickets: inquirer.com/healthstory.