Acupuncture is a controversial subject. Some claim the practice is all pseudoscience with no basis in facts, others that it can cure a number of serious diseases. Many medical practitioners believe the answer lies somewhere in the middle. But did you know that acupuncture can be performed on dogs or cats too? The controversies surrounding acupuncture have migrated to veterinary medicine as well. So today we will discuss what is the evidence behind acupuncture; and how this may relate to your cat or your dog.
Table of contents
- What is Acupuncture?
- How Might Acupuncture Reportedly Work Physiologically in dogs and cats?
- What’s the Evidence Behind Acupuncture?
- How Would a Vet Perform Acupuncture?
- Potential Benefits of Veterinary Acupuncture
- Potential Risks of Veterinary Acupuncture
- Final Thoughts
What is Acupuncture?
At its simplest, acupuncture can be defined as the “insertion of a solid needle into the body for the purpose of therapy and pain relief”. Variants of acupuncture include acupressure (placing pressure on an area); aquapuncture (injecting liquids into an area); and moxibustion (using a specific herb over an area). Acupuncture has been around for thousands of years, originating in India, Tibet or China, becoming popularised in the latter. The first reference to animal acupuncture detailed a famous Chinese veterinary acupuncturist who helped heal war horses around 650BCE. While the first primary source describing acupuncture was from the Han dynasty, approximately 200-100BCE.
Traditionally, acupuncture is deeply rooted in Chinese philosophy and ways of thinking
This includes the concepts of Yin and Yang, the Five Phases, and Qi (Chi). This style of acupuncture is considered part of Traditional Chinese Medicine (TCM). While the acupuncture first developed in modern times in the West is referred to as scientific acupuncture. Traditional acupuncture tends also to be holistic, taking the whole person or animal into account. This style of thinking is getting more popular in Western medicine as we understand how interconnected things are, from different body systems, to organisms and their environments. Scientists often say TCM is archaic and not based on any study; while TCM-proponents say science does not explain all the varied effects of acupuncture. Much of the discord has also been heightened by the language barrier and a lack of studies translated into English.
These two terms are contentious as they imply that TCM is not necessarily based on science, so could be considered derogatory. Furthermore, Chinese medicine split around 220CE into traditional medicine and medicine similar to that seen in modern times; meaning it is not necessarily accurate. Finally, it has been reported that TCM was all but wiped out after suppression by the Chinese Communist Party in the 1950s, and thus the practice had to be reinvented completely, meaning TCM practised today may not even correlate to ancient Chinese medicine. However, for simplicity’s sake, we will continue to refer to TCM and scientific acupuncture to distinguish the two ways of thinking.
Two totally different ways of thinking
The point of this preamble is that despite scientific acupuncture trying to rely on scientific studies or research and clinical experience, while traditional acupuncture relies more on traditions and empirical evidence, most modern acupuncturists try to strike a balance between both styles of thinking. Science has possibly explained why many aspects of traditional acupuncture works. (For example, Yin and Yang can be considered the sympathetic and parasympathetic nervous systems); and cannot yet fully explain other beneficial aspects of acupuncture. To quote one textbook, “…TCM theory has been the basis of acupuncture teachings for over 3000 years… [and] to simply ignore this wealth of empiric knowledge would not be beneficial at this time.”
How Might Acupuncture Reportedly Work Physiologically in dogs and cats?
The science behind acupuncture in humans – let alone dogs and cats – is incredibly complex and not fully understood. As mentioned above, we currently don’t have evidence explaining all of the beneficial effects behind acupuncture. But we have scientific studies demonstrating some of them. In short, there is some scientific evidence proving acupuncture can work; but the following is not complete, and may even be incorrect.
Understanding acupuncture fully requires a deep understanding of the brain, central nervous system and pain transmission. We will not go into too much detail here as it is complex and, again, not fully understood. Pain is the body’s response to stimulation of nociceptors (pain receptors), which are free nerve endings responding to certain stimuli, such as heat, pressure, chemicals and more. Stimulation occurs as a result of probable or actual damage to nearby tissue. When the nociceptors are stimulated, they carry a signal up to the dog’s or cat’s brain via the spinal cord for the brain to process and respond to. One of the most important responses is pain modulation; this is where the response to a potentially painful stimulus is altered depending on multiple factors. This is why the same damage may be more or less painful for different individuals or at different times.
Acupuncture involves a needle being placed into specific points of the skin
TCM acupuncture has thousands of these points, known as acupoints; while science-based acupuncture has fewer that are referred to as trigger points. Trigger points are generally free nerve endings under the skin that, when stimulated, cause pain in a nearby or remote area due to muscle tension, muscle spasm, or inflammation. A study has found that over 70% of the acupoints correspond to trigger points, again demonstrating some evidence behind traditional acupuncture.
When trigger points/acupoints are stimulated via a needle, a pain signal is sent to the brain. This signal tends to be low level, as the pain from a needle is not severe. The brain and CNS then release chemicals (neurotransmitters) to block pain. These neurotransmitters will also block pain caused by other stimuli, such as arthritic pain. It is in this way acupuncture can cause pain relief. Because pain and sensation is required for acupuncture to work, tissue that is paralysed or anaesthetised with local anaesthetic will not respond to acupuncture.
Acupuncture also alters the function of the limbic system
The limbic system is a part of the brain responsible for emotion. By reducing activity in the limbic system, the emotional component of pain is reduced. This reduces suffering, best described as the unpleasant feelings you get in response to negative events (in this case pain). This has been demonstrated with MRI studies.
It has been shown that acupuncture has a cumulative effect; meaning over time repeated sessions of acupuncture can increase pain relief. This is possibly because acupuncture ‘fools’ the brain into thinking the acupuncture-sites are damaged. Thus it must release potent pain relief in the area more often.
Beware the placebo effect – even in animals
Non-specific effects are those with no apparent explanation. These may be due to the patient’s belief in the treatment (the placebo effect), and this has been shown in studies with humans. Though the placebo effect has been shown to exist in animals, especially dogs but also cats, horses and other pets, often the placebo is from the owner; the owner believes the animal is healthier even when they are not. This may be dangerous as it can result in the animal not being treated properly.
What’s the Evidence Behind Acupuncture?
Unfortunately, this is an incredibly difficult question. There are a myriad of papers demonstrating the benefits of acupuncture, and many more demonstrating no effect. Because acupuncture is a controversial subject, some of the debate may be rooted in personal belief. For example, veterinary acupuncture textbooks list many sources backing up their claims (though of course they do not go into detail). While the English language Wikipedia entry for acupuncture (while not a primary source, a good demonstration of Western thought and bias) lists acupuncture under ‘pseudoscience’.
While many studies have shown some beneficial effects, literature reviews claim that a lot of these studies do not hold up to scrutiny. This may be due to small study size, lack of proper controls, high variation within a study, overinterpretation of data or even bias. Studies in animals are even more scarce, making it harder to judge whether it is appropriate to perform in animals.
We also want to reiterate again the difficulties in translating studies from Chinese into Western languages that has, until recently, meant investigating Chinese studies’ claims has been difficult. Many Western scientists claim Chinese studies do not hold up to scrutiny and are biased towards promoting TCM. This may partly be true, or partly based on misunderstanding, maybe even xenophobia.
In short, there are lots of preliminary studies demonstrating the effectiveness of acupuncture, but rigorous scientific studies are lacking. This does not disprove acupuncture, but we have not fully proved it’s efficacy either. Empirical evidence from thousands of patients seem to imply there is some benefit to acupuncture; but this may be exaggerated by the placebo effect. We agree that to ignore thousands of years of knowledge seems foolish, but always take the claims surrounding acupuncture with a pinch of salt, particularly when it comes to dogs, cats and other animals.
How Would a Vet Perform Acupuncture?
First of all, it is important to note that in the UK, acupuncture is considered an act of veterinary surgery. This means that legally, only a vet (or a veterinary nurse under veterinary surgeon guidance) can perform acupuncture. Many vets will not be familiar with acupuncture, so you may have to find one specially to have it performed. There is an Association of British Veterinary Acupuncturists (ABVA), and an International Veterinary Acupuncture Society. Finding a vet who is a member of either of these is a good start.
The ABVA state that acupuncture should only follow an accurate diagnosis of the disease, and discussion of all other treatment options. They also advise that acupuncture is best utilised alongside conventional medicine, though can be used alone. Musculoskeletal disorders, such as arthritis, muscle pain or intervertebral disc disease, as well as post-orthopaedic surgery, are some of the most common cases where acupuncture is used. It is recommended that dogs and cats should receive x-rays, CT, MRI, blood tests and more to confirm diagnosis of these diseases. Acupuncturists claim that other conditions, such as neurological, gastrointestinal and urinary disorders can also be managed with acupuncture. If your pet has any of these, they may be a candidate.
In small animals – dogs and cats
Acupuncture needles for dogs are generally 25-34 gauge (very thin) and 1.25-5cm long; for cats, similar equipment is used but often shorter needles are more appropriate. They may be reusable and sterilised between uses, or single use – single-use is recommended. Acupuncture textbooks report that acupuncture can be performed on most animals conscious, and may even fall asleep. Those that are very excitable, anxious or aggressive may require restraint, muzzling or light sedation.
Needles are inserted at specific points (either acupoints or trigger points depending on the practitioner) near the site of pain, and often left in for 15-20 minutes. Textbooks recommend sessions 1-2x a week for 3-5 weeks. They note that improvement is often not seen until the final sessions. After this, sessions are tapered to as few as possible to keep the dog or cat comfortable.
Potential Benefits of Veterinary Acupuncture
If acupuncture results in even some of the reported benefits, the main advantage of veterinary acupuncture is providing another option for pain relief in dogs and cats with chronic conditions, such as arthritis. This primarily should be in addition to more common methods of pain relief, such as drug therapy, physiotherapy, hydrotherapy or laser therapy. However, acupuncture may allow some dogs (especially) to reduce or even stop drug therapy, as claimed by some studies. This is beneficial for older dogs and cats or those with underlying health conditions. Some pets may not even be able to have drugs due to intolerance, and many medications are higher risk in cats, so acupuncture may be a safer alternative.
In some cases, dogs and cats are in such severe pain that their body may not be responding to drug therapy, so acupuncture may ‘relax’ the body enough to allow drugs to start working. For pets with terminal illness or those approaching euthanasia on welfare grounds, acupuncture may provide a ‘last resort’ before saying goodbye, though care should be taken not to prolong suffering if acupuncture is not effective or slow to start working.
Acupuncture also has the advantage of allowing a vet to examine and interact with an animal and client more frequently. This builds a vet-patient bond, gives the vet more chances to spot deterioration in the dog, cat, horse or even rabbit, and may be a more comfortable and positive experience at the vets than routine checks.
Potential Risks of Veterinary Acupuncture
In humans, acupuncture has been shown to be generally safe when performed by a trained practitioner. This is likely to be true with veterinary acupuncture as well. However, there have been rare serious complications in humans, including damage to organs and the spread of blood-borne infections like hepatitis C and HIV. These are likely to be risks in animals as well. However, the data notes that these are very rare and probably linked to poor training and technique. The advantage of veterinary acupuncture requiring a vet or nurse to be performed should hopefully minimise these risks. The most common side effect is pain or bleeding at the site of the needle. They do note that side effects are likely to be underreported however.
The other significant risk associated with veterinary acupuncture is a possible lack of efficacy
With claims that acupuncture can take weeks to start working, this may leave an animal in chronic pain for long periods. Leaving a dog or a cat in pain to see if acupuncture works is inhumane. Thus, it is recommended that acupuncture should be used as an adjunctive, and other therapy should only be stopped if acupuncture is shown to be effective.
Part of this risk is the placebo effect on the part of the owner – as we already discussed, if the owner perceives an improvement in their pet’s wellbeing but the pet is not actually improving, this may result in suffering and lack of treatment. Owners should always be mindful of this and work with their vet to assess whether their pet actually has responded to acupuncture.
Finally, there is a theoretical risk, according to one textbook, that if pain because of a tumour has been misdiagnosed, acupuncture may hasten the growth of the cancer by increasing blood flow to the area. This can hopefully be mitigated with a thorough investigation before acupuncture is started, but the risk should be discussed thoroughly.
Acupuncture has been used for thousands of years and will likely be used for years to come, in both humans and animals. Many people, both doctors and patients, report a wide variety of benefits to acupuncture, but modern scientists are still sceptical. Whether due to pain modulation or placebo, pain relief may be gained from acupuncture. In animals especially, care must be taken not to overinterpret the results, or discontinue proven pain relief methods in favour of acupuncture. If you are considering acupuncture for your dog, your cat, your rabbit, your horse, or any other animal, please discuss it with your vet, whether it is right for them, and how you might go about this.
Sources and further reading:
- Pain Management in Animals, Paul Flecknell and Avril Waterman-Pearson, 2000
- Veterinary Acupuncture – Ancient Art to Modern Medicine, 2nd ed. Allen M. Schoen, Veterinary Institute for Therapeutic Alternatives, 2001
- Association of British Veterinary Acupuncture
- International Veterinary Acupuncture Society
- BSAVA Guide to Pain Management in Small Animal Practice, Ian Self, 2019
- Acupuncture – NHS
- Acupuncture – a critical analysis – ERNST – 2006 – Journal of Internal Medicine – Wiley Online LibraryAcupuncture: What You Need To Know | NCCIH