Getting to the Point: Equine Acupuncture

A review of the existing science behind equine acupuncture

With tightening sport horse competition drug regulations, increased scrutiny surrounding horse racing, and the general public’s desire to turn toward natural alternatives to medications, many veterinarians are seeing a rising demand for equine acupuncture. In the Western Hemisphere acupuncture has become an increasingly acceptable treatment modality. In fact, a 2017 survey of 423 horse owners in the U.K. found that 81% were willing to try a complementary or alternative form of veterinary medicine.1

Even if you are open to equine acupuncture, how much do you really know about this therapy? In this article we’ll explore the scientific basis of equine acupuncture, so you can come to your own informed decision about pursuing it to treat your horse’s ailments.

A Primer on Terminology

Many people use words such as holistic, alternative, complementary, and integrative medicine interchangeably. Although each of these categories includes acupuncture, each term has a distinctly different meaning.

Holistic medicine refers to a type of practice that looks at an animal as a whole while considering its environment and nutrition. Alternative medicine uses nonmainstream practice to replace conventional medicine, while complementary medicine uses conventional medicine together with nonmainstream practice. Integrative medicine combines all forms of holistic care, wellness, and medical practice in a coordinated fashion.

The History Behind Equine Acupuncture

Acupuncture is simply the stimulation of a specific point using a sharp object, such as a needle, to create therapeutic effects. Equine veterinary acupuncture traces back to ancient China’s Tang Dynasty in 618-907.² Although its origins have not been described, many feel it might have been observational, from recording unintentional treatments from being struck with sharp objects, thus serving as the longest clinical trial in medical ­history.

Despite its popularity, equine acupuncture has limited scientific evidence behind it. Researchers have conducted only two systematic reviews of companion animal acupuncture literature in the English language, and both concluded that most scientific evidence of veterinary acupuncture’s efficacy was nonexperimental and of low quality (not randomized and controlled trials) and, therefore, inconclusive.

How Does it Work?

Western-medicine-trained horse owners and veterinarians can struggle to understand acupuncture in traditional Chinese veterinary medicine (TCVM) terms—words like qi, theory of five elements, internal and external pathogens, meridians, and yin and yang.

From a Western perspective, acupuncture works through neuromodulation, meaning it normalizes function throughout the nervous system. Acupuncture points correspond to areas of decreased electrical resistance and increased conductivity, as well as increased density of free nerve endings, small blood and lymphatic vessels, and mast cells (immune cells found in connective tissues).

From a physiology standpoint, acupuncture elicits a response at different levels of the nervous system.³ First, it causes local effects, such as increasing blood flow to a certain point and relaxing the surrounding muscle and tissue. Second, it causes segmental effects, as most meridians (pathways of acupuncture points) correlate with nerve pathways. This means stimulating an acupuncture point can cause nerve impulses to travel up the pathway and into the spinal cord. Third, it has central effects, meaning functional MRI (brain imaging) has shown different effects on the brain when an acupuncture point is stimulated. Finally, it affects the endocrine (hormone) system by changing the level of natural chemicals and opioids in the central nervous system.

Is it Effective?

As early as 1997, the National Institutes of Health concluded that acupuncture was effective in treating human nausea and dental pain and was useful for myriad medical issues ranging from osteoarthritis to low back pain to asthma.4 Since then, researchers have performed many case studies and experimental studies on the efficacy of acupuncture in horses, dogs, and cats. However, in a review of 843 references, Canadian scientists found only four hypothesis-driven (more likely to be scientifically sound) studies.5

Meagan Smith, DVM, Dipl. ABVP, assistant professor of Clinical Equine Field Service at the University of Pennsylvania’s New Bolton Center, in Kennett Square, primarily uses acupuncture “for musculoskeletal maintenance or to help musculoskeletal issues,” she says. “Trainers and riders of the horses I perform monthly maintenance treatments on truly believe their horses feel better for at least a couple weeks after treatment—more supple and freely moving.”

Indeed, the most common indication for acupuncture in companion animal literature is to alleviate pain and treat lameness conditions. Researchers have found acupuncture to be 98% effective for treating back soreness in companion animals (dogs, cats, and horses), with increased pain threshold (measured as twitching in response to heat stimulus), increased skin temperature, and increased endorphins in the spinal fluid.5

Penelope Rochelle, DVM, CVA, CVSMT, equine acupuncturist and co-owner of Blue Sage Veterinary Wellness Center, in Little Silver, New Jersey, finds acupuncture “to be very effective … for the treatment of sports injuries in equine athletes, navicular/heel pain cases, and equine neck and back dysfunction. It is also instrumental in helping reinforce postural changes necessary for a healthier spine and greater athleticism.”

When used to treat arthritis, acupuncture seems to provide pain relief, although it does not reverse the process. Studies on its efficacy with lameness cases have produced mixed results. For example, in a single clinical study involving horses with laminitis and navicular disease, researchers found no significant difference in lameness between those treated with acupuncture and those not.

For treatment of gastrointestinal (GI) disorders, acupuncture’s efficacy comes from its ability to alter blood flow to organs, decrease pain by releasing opioids into the bloodstream, and normalize GI motility.6 Acupuncture should not, however, replace colic surgery. Although it increased affected horses’ pain thresholds in one study, it was not as effective as readily available injectable medications such as butorphanol.² Acupuncture also does not decrease clinical signs of colic pain and is not recommended as the primary intervention for colic. For horses with diarrhea, acupuncture points do seem to have some positive effects on regulating GI motility.6

For respiratory conditions such as equine asthma, study results show that acupuncture can help dilate the airways, making it easier for affected horses to breathe. That said, clinical trials have not shown statistically significant differences between lung parameters of equine asthma patients treated with or without acupuncture.

Infertility is a common area of application for acupuncture, especially in human medicine. In horses acupuncture reduces abnormal fluid accumulation in the uterus, resulting in increased fertility.² Aquapuncture (injection of solution into acupuncture points) can also help regulate the heat cycle and, so, reduce the need for high-dose medications. An integrative approach including TCVM and Western medicine can, therefore, effectively normalize equine patients with reproductive diseases.

Physicians use acupuncture to treat various ophthalmic conditions in humans, including dry eye and glaucoma. Although stimulating local acupuncture points around the eye seems to be anecdotally effective, and efficacy has been proven in dogs and rabbits, there have been no controlled studies performed specifically in horses to support this.

Nicole Estes, DVM, associate practitioner at Genesee Valley Equine Clinic, in Scottsville, New York, and owner of Woods Dry Veterinary Services, has used acupuncture “to help control pain and other clinical signs associated with glaucoma and equine recurrent uveitis (aka moon blindness). I am always quick to remind owners that we are treating a disease process with a balanced approach, utilizing Western medications along with Eastern medicine,” she says.

Neurologic conditions in horses resulting from peripheral nerve injuries seem to respond well to acupuncture. For example, sweeney (suprascapular nerve paralysis in the shoulder area), facial nerve paralysis, and laryngeal neuropathy (roaring) appear to respond to electroacupuncture treatment (electrical stimulation of acupuncture points).6

Researchers have shown that four horses suffering from anhidrosis (an inability to sweat) that received aquapuncture in conjunction with other TCVM treatments experienced positive results.²

What You Should Know Before Scheduling an Appointment

Most acupuncture sessions last about 30 minutes. Based on his or her clinical experience, your veterinarian will need to perform at least three treatments to see improvement in lameness conditions. While acupuncture is a safe modality with few to no harmful effects reported, talk to your veterinarian before having acupuncture performed on horses that are pregnant, very young, very old, or have been diagnosed with critical illnesses.

“One of the biggest attributes of acupuncture is that it very rarely has negative side effects, especially when compared to conventional treatments for chronic disease states,” says Rochelle. “It is often successful in cases where no other options are available or where all other treatments have tried and failed. It also provides an alternative in cases which cannot be treated with more aggressive means.”

It is important to seek a qualified acupuncture practitioner, as many acupuncture points are located near joints and other important anatomical structures. Acupuncture practitioners must be licensed veterinarians. Although there is no comprehensive directory of equine acupuncturists, many schools list practitioners who have completed training and been certified by those programs:

Take-Home Message

Research results on acupuncture’s effects on various equine conditions are mixed. The studies that do exist support using acupuncture to treat back pain, relieve arthritis pain, improve pain threshold in colic, regulate GI motility in chronic diarrhea cases, and help treat fertility, nerve paralysis, and anhidrosis. Limited evidence exists as to its efficacy for treating equine asthma, and no equine-specific studies have been conducted on its effects on eye conditions. In general, we need more well-designed experiments to generate more scientific evidence on acupuncture’s efficacy and place in treating equine conditions and to discover what points and acupuncture methods are most effective.

References

1. Thirkell J, Hyland R (2017). A survey examining attitudes towards equine complementary therapies for the treatment of musculoskeletal injuries. Journal of Equine Veterinary Science. 59 (2017) 82–87.

2. Tangjitjaroen W, Shmalberg J, Colahan PT, Xie H (2009). Equine acupuncture research: An update. Journal of Equine Veterinary Science. 29(9), p. 698-707.

3. Robinson, N. (2009). Making sense of the metaphor: How acupuncture works neurophysiologically. Journal of Equine Veterinary Science. 29(8): p. 642-644.

4. National Institutes of Health. (1997, Nov. 3-5). Acupuncture.

5. Rose WJ, Sargeant JM, Hanna WJB, Kelton D, Wolfe DM, Wisener LV (2017, Dec. 11). A scoping review of the evidence for efficacy of acupuncture in companion animals. Animal Health Research Reviews. 18(20): p. 144-185.

6. Shmalberg J, Xie H (2009). The clinical application of equine acupuncture. Clinical Techniques. 29(10): p. 753-760.