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Chronic Pain

Last year, a really interesting research project looked at the effectiveness of acupuncture for treating

  • Chronic back pain
  • Chronic neck pain
  • Osteoarthritis
  • Headache and migraine

This was a systematic review (Vickers et al 2012) which used data from 29 high quality clinical trails, and included a total of 17,922 patients. The researchers only chose the most robust studies published, and studied the individual participants’ self-reports of pain. In this way, the authors could assess with more confidence acupuncture’s true effect on participants’ reports of pain before and after treatment. The result was

a clear and “robust” effect of acupuncture in relieving chronic pain in the back, neck and shoulders, as well as pain due to osteoarthitis and headaches.

Compared with people undergoing sham needle treatments, those receiving acupuncture reported a reduction in back and neck pain of 0.23 standard deviations, and of 0.55 standard deviations compared with those not using acupuncture at all. On a pain scale of 0 to 100, that meant that among the participants, who started out with an average baseline pain score of 60, pain ratings fell to 30 on average for those who got acupuncture, 35 for those who received fake acupuncture, and 43 for people who got usual care and no acupuncture.

How does it work?

Some doctors say the needles may release endorphins, the pleasure-inducing, painkilling chemicals that saturate the brain and numb pain signals. But such theories can’t fully explain why acupuncture patients report that their chronic pain episodes become less frequent and less intense over time.

In Chinese medical theory, there may be a number of different underlying causes for painful conditions and each patient is assessed and diagnosed according to their own symptoms and circumstances. The treatment approach might be quite different for patients who have the same conventional medical diagnosis.

For example, someone whose back pain comes on towards the end of the day when they start to get tired, who feels the cold easily and has a pale complexion would be seen as having pain arising from a deficient condition. Their treatment would be based around strengthening and warming both their back and their whole system.

Another typical case might involve someone who is fit and strong, with a job that involves physical hard work. They may find it hard to relax, always on the go, and have severe back pain that kicks in when they bend or move in a particular way and lasts for a few days, or even weeks. This would be seen by an acupuncturist as an excess condition and would be treated by releasing and dispersing muscle tension.

Although both of these people have chronic back pain, the way acupuncture treats them is very different in terms of the positioning and number of needles, the use of warmth or other associated techniques, and the supporting advice and exercises that may be offered.

This may be one of the reasons that acupuncture is effective in reducing pain in the long term. A clinical trial which looked at the longer term outcomes for people with persistent non-specific low back (Thomas et al 2006) found that a short course of acupuncture was still giving benefit after 2 years. In fact the improvement they felt after 2 years was stronger than it had been at 12 months.

Acupuncture is an effective treatment for chronic pain and has the added advantage of being safe and with virtually no side effects.

References

Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, Sherman KJ, Witt CM, Linde K; Acupuncture Trialists’ Collaboration (2012) Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012 Oct 22;172(19):1444-53. doi: 10.1001/archinternmed.2012.3654.

Thomas AJ, MacPherson H, Thorpe L, Brazier J, Fitter M, Campbell MJ, Roman M, Walters SJ, Nicholl J. (2006) Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain. BMJ 2006; 333:623 doi: http://dx.doi.org/10.1136/bmj.38878.907361.7C (Published 21 September 2006)

Howard, 60

“Every so often, hard physical work on the farm, leaves me with terrible aches and pains. My shoulders and arms in particular can be agony. I come for acupuncture with Harriet and I feel pounds better. It really does the trick.”

Helen, 58

“After picking up my grandchildren, my back ache got a lot worse and I had really bad pain in my leg. Pain killers helped a bit, but I didn’t like taking them. The massage and acupuncture made a big difference to me. After 4 or 5 treatments the pain has almost gone, I’m sleeping better and I feel 10 years younger.”