Raynaud’s phenomenon is caused by episodic vasospasm and ischemia of the extremities (especially the fingers and toes) in response to a fall in temperature (even taking a cold milk bottle out of the fridge or a cool wind on a hot beach (RSA 2012)) or an emotional stimulus.(Goundry 2012) This response results in a characteristic color change in the extremities from white, to blue, to red. In about 89% of people, Raynaud’s occurs in direct response to a stimulus and there is no known underlying cause. In the other 11%, it results from an underlying condition, most commonly a connective tissue disease such as systemic sclerosis, mixed connective tissue disease.(Goundry 2012)
Around 3-12.5% of men and 6-20% of women have reported symptoms of Raynaud’s phenomenon in non-population based studies.(Fraenkel 2002) The prevalence varies widely across countries and populations but is higher in colder climates. In women, it is often associated with a family history, estrogen exposure, and emotional stress.(Fraenkel 2002) In men, smoking and hand-arm vibration syndrome are more commonly implicated.(RSA 2012; Palmer 2000)
There are few conventional treatments on offer. Lifestyle modifications such as regular exercise and stopping smoking, and reducing exposure to triggers (e.g. cold, emotional stress) can help. Nifedipine is currently the only drug licensed in the UK for use in Raynaud’s phenomenon, although other drugs are under investigation. Very rarely, surgery is indicated.
How Acupuncture Can Help
This Factsheet focuses on the evidence for acupuncture in the treatment of Raynaud’s phenomenon. Overall, very little research has been published on the effects of acupuncture in patients with Raynaud’s phenomenon. There are no systematic reviews looking specifically at acupuncture, but one that assessed the evidence of the effectiveness of non-surgical symptomatic interventions, in general, concluded that more high-quality, well-designed trials are needed to assess the effects of acupuncture in Raynaud’s phenomenon.(Huisstede 2011) Two randomized trials have been published, with conflicting results. One found that a specific vasospasmolytic effect of acupuncture could not be proven.(Hahn 2004) The other found that traditional Chinese acupuncture may be a reasonable alternative treatment for patients with primary Raynaud’s syndrome.(Appiah 1997). The contrasting outcomes may primarily be due to the different types of control groups employed. So-called placebo controls (as in Hahn 2004) are usually modified, and at least partially active, forms of acupuncture, making the results difficult to interpret.
An uncontrolled study found that auricular electroacupuncture appears to reduce symptoms by reducing the frequency and severity of attacks in primary Raynaud’s phenomenon, but not to influence skin perfusion and skin temperature.(Schlager 2011) In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules.
The resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being.
Research has shown that acupuncture treatment may specifically help to relieve the symptoms of Raynaud’s by:
– Increasing local microcirculation (Komori 2009);- Regulating endothelium-derived vasoconstrictors (endothelin-1) and vasodilators (calcitonin gene-related peptide, nitric oxide, and nitric oxide synthase) (Wang 2011a; Wang 2011b; Pan 2010; Kim 2006);- Reducing inflammation, by promoting the release of vascular and immunomodulatory factors (Kavoussi 2007)
Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);
– Increasing the release of adenosine, which has antinociceptive properties (Goldman 2010).
– SOURCE: Fraenkel L. Raynaud’s phenomenon: epidemiology and risk factors. Curr Rheumatol Rep 2002; 4: 123-8. Goundry B et al. Diagnosis and management of Raynaud’s phenomenon, BMJ 2012; 344: e289 doi: 10.1136/bmj.e289 Palmer K et al. Prevalence of Raynaud’s phenomenon in Great Britain and its relation to hand transmitted vibration: a national postal survey. Occup Environ Med 2000; 57: 448-52.