Another CAM and TM modality that has considerable accept- ance is pain management clinics, hospitals, and academic centers in the West now provide acupuncture services, and some insurance companies reimburse for acupuncture services. Rigorous clinical trials have demonstra- tive positive efficacy in two areas: (a) management of postop- erative nausea and emesis (Shen and others 2000) and (b) ame- lioration of the pain of chronic osteoarthritis (Ezzo and others 2001; Soeken 2004; Tukmachi and others 2004). Studies pro- viding rational explanations of the mechanisms whereby acupuncture might be achieving its effects complement the evi- dence about its efficacy; for example, one mechanism of action appears to involve opioid-dependent brain pathways. This.
