Acupuncture is an effective treatment for chronic pain conditions
Acupuncture is called ancient art and has been used in Asia for centuries to treat many conditions and relieve pain. It is now being recognised in western countries, such as USA and European countries. It is used to ease back pain, nerve pain and other pain conditions.
If a pain last over 3 month, it is chronic. Chronic pain is a common condition. It can occur in many places such as low back pain, neck pain, headache, migraine and knee pain. Chronic pain in the muscles and joints can make life miserable. Many simple treatments like ice and heat, anti-inflammatory medications, physical therapy, and appropriate exercises can often ease the pain. If these methods don’t work, not everyone is able or willing to take pain medication every day, and not everyone can or should have surgery for painful conditions.
Chronic pain is very common and difficult to manage. Apart from pain killers, acupuncture is well accepted to treat chronic pain conditions. Complementary and alternative medicine (CAM) plays an important role to reduce pain and improve quality of life for those who suffer from chronic pain. A survey by MG Tan et al from Singapore studied the use of CAM in chronic pain patients in Singapore. They found that 84% of patients used CAM at some point of their life. 30% of patients used CAM for other reasons instead of chronic pain. 35% of patients used for both pain and non pain conditions. Acupuncture was the most utilised which is 49%, followed by Chinese herbs (18%), Tui Na (17%) and massage (16%). Many patients were on more than one form of the CAM. 72% patients thought that CAM helped with their pain. 26% patients used CAM because conventional medicine did not work. 38% thought it was safer and had fewer side effects. 24% of patients thought it was cheaper. 85% of patients were satisfied. Many patients did not discuss the use of CAM with their doctor, mainly because they thought that CAM is more natural and safe.
Acupuncture has little side effects and well tolerated. A survey from people accepted acupuncture treatment has shown that 46% said acupuncture helped greatly, 26% said it helped in some degree and 28% said there was little help. Research showed that lower back pain is the most common reason for visiting acupuncturists. Usage of acupuncture has increased enormously in recent 10 years.
Recently, Mao et al reviewed clinical research of a few chronic pain condition treatments with acupuncture including lower back pain, knee pain, neck pain and headache. Low back pain is the most common reason for visits to acupuncturists. Recent 10 years, using high quality randomized controlled trials study acupuncture has increased enormously. Most of them have shown that acupuncture treatment is effective to lower back pain and it is better than no treatment or equivalent to other conventional treatments. The situation of knee pain with acupuncture treatment is pretty similar to lower back pain which is acupuncture is better than no treatment. For neck pain treatment with acupuncture some controlled trials suggested that acupuncture is better than or equivalent to physiotherapy. Some study suggested that acupuncture is better than massage and dry needling in motion-related neck pain. In a study on headache, it showed that acupuncture reduced headache frequency and severity, and at the same time it also improves headache related quality of life. There is a review about acupuncture for chronic pain by Vickers AJ et al just published in Arch Intern Med (2012). They analysed 29 clinical randomized controlled trials involving in 17922 patients to investigate the effect of acupuncture for 4 chronic pain conditions: back and neck pain, osteoarthritis, chronic headache and shoulder pain. In the primary analysis, including all eligible trials, acupuncture was superior for both sham and no acupuncture control for each pain condition. After exclusion of an outlying set of trials that strongly favoured acupuncture, the effect sizes were similar across pain conditions analysed. Patients receiving acupuncture had less pain. They concluded that acupuncture is effective for the treatment of chronic pain and it is more than a placebo. Acupuncture is clearly a treatment option.
It becomes general knowledge that acupuncture releases pain effectively. However the effectiveness of acupuncture for pain relief is still coming up for debate and there are always some clinical trials showing lack of effect compared with control. What is the reason for this? Macpherson et al analysed clinical trials involving patients with headache and migraine, osteoarthritis, and back, neck and shoulder pain. There were many different types of controls used in the trials including sham controls such as non-needle sham, penetrating sham needles and non-penetrating sham needles and non sham control such as non-specified routine care and protocol-guided care. They analysed the impact of choice of control on effect of acupuncture. They found that acupuncture was significantly superior to all categories of control group. For trials that used penetrating needles for sham control, acupuncture had smaller effect sizes than for trials with non-penetrating sham or sham control without needles. Large effects of acupuncture were seen after exclusion of outlying studies. In trials with non-sham controls, larger effect sizes associated with acupuncture vs. non-specified routine care than vs. protocol-guided care. From this study it can be seen that acupuncture is significantly superior to control irrespective of the subtype of control. Penetrating needles can have positive effects which should be avoided as a control in the study.
Recently a study analysed 29 clinical trials involved in 17922 patients with chronic pain treated with acupuncture. This study suggested that acupuncture is effective for the treatment of chronic pain including back and neck pain, osteoarthritis, and chronic headache and acupuncture is a reasonable option. There is scientific evidence how acupuncture works. Many research suggested that acupuncture relives pain by affecting neurotransmitters, hormone levels, or the immune system.
What is important when using acupuncture to treat chronic pain
Many researches with huge sample sizes showed that acupuncture is effective to treat chronic pain. Acupuncture is not a standardized treatment method. If you see different acupuncturists, you would receive acupuncture with different characteristics for sure. There are different styles of acupuncture, Chinese acupuncture, Western acupuncture or mixed Chinese and Western acupuncture, which are based on different theories. Even for the same style of acupuncture, the duration and frequency of the treatments could be different performed by different acupuncturists. The points used could be different as well. Additional usage of electrostimulation or electroacupuncture, moxibustion or manipulation could be applied by some acupuncturists.
From research point of view, there is a great variation of acupuncture characteristics. MacPherson et al analysed the research trials for acupuncture effect on chronic pain. Majority of research trials (59%) was based on traditional Chinese acupuncture and majority of points (55%) selected were flexible. Most of the research trials are manually stimulated and only a few trials used electrical stimulation and a few trials added with moxibustion. Attempts to obtain de qi sensation were made in all 25 trials which provided this information. The maxium number of sessions varied broadly from 3 to 30 and duration of sessions also varied from 15-32 minutes. The needles or points used were range from 1-18 points. The frequency of treatment was from one session every eight days to two sessions a week.
Their results showed that when comparing acupuncture with sham acupuncture controls, there was little evidence that the effects of acupuncture on pain were modified by any of the acupuncture characteristics evaluated, including style of acupuncture, number or placement of needles, the number, frequency or duration of sessions, patient-practitioner interactions and experience of the acupuncturist. When comparing acupuncture to non-acupuncture controls, better pain outcomes were obtained when more needles were used and also when a higher number of acupuncture treatment sessions were provided. They conclude that there was little evidence that different characteristics of acupuncture or acupuncturists modified the effect of treatment on pain outcomes. Increased number of needles and more sessions are associated with better outcomes when comparing acupuncture to non acupuncture controls. They suggested that dose is the key factor.
There was a report that investigated the outcomes of acupuncture for chronic pain in urban primary care from New York. Patients selected for the acupuncture treatment were over 21 years old with chronic pain caused by osteoarthritis or neck or back pain. Acupuncture was provided by supervised acupuncture students for up to 14 weeks. Pain and function were evaluated before during and after acupuncture treatment. They found that back pain was the most common referring diagnosis 59.5% followed by osteoarthritis 16.3%. Pain severity and function significantly improved at 12 and 24 weeks after baseline assessment. They concluded that weekly acupuncture improved pain severity and quality of life.
Why can acupuncture be used to relive pain?
Acupuncture can act as a pain killer and it is used in many conditions and helps relieve pain. The mechanism is studied by modern research. Studies have shown that pressure pain threshold is increased after acupuncture treatment. The effect could be long-term and short-term. Studies have also shown that acupuncture reduced sensitivity to noxious thermal stimuli which could be mechanical (such as pinching or tissue deformation), chemical (such as exposure to acid or ittitant) or thermal (such as high or low temperature). Sensory threshold changes were equally frequent reported after manual acupuncture as after electroacupuncture. Acupuncture affects sensory perception. Results are most convincing for the pressure pain threshold, especially in pain conditions associated with tenderness.
Acupuncture is used for women with chronic pelvic pain
If you've had pelvic pain for six months or more that either comes and goes or is continuous, it is known as chronic pelvic pain (CPP). CPP is more intense than ordinary period pain and lasts for longer. It affects around one in six women. A research paper studied the prevalence of and factors associated with use of complementary health approaches mong women with CPP. The result has shown that slightly over one-half (51%) of women with CPP used at least one complementary health approach in the past year, including acupuncture (8%), special foods or diets (22%), herbs (27%), and vitamins and minerals (29%). During follow-up surveys conducted annually for 4 years, a substantial proportion of women (44.8%) used complementary health approaches at more than half of the assessments. Users of complementary health approaches were more likely to undergo a hysterectomy or oophorectomy or to use gonadotropin-releasing hormone agonists or opioids during the study compared with nonusers. Women with CPP who used complementary health approaches also had more optimal health-related quality of life measured by the Pelvic Problem Impact Questionnaire.
Acupuncture is the best option for depression with pain problems
Up to about 70% patients with depression also have pain problems. Depression may make the pain problem worse and more pain may make depression worse as well. The existing research data has shown that acupuncture is an effective treatment option for several chronic pain conditions. Acupuncture is also suggested to treat depression, though this is not available option in NHS. Counselling for depression is widely available in primary care practices, however there is limited evidence for counselling compared to usual care as a treatment for patients with depression and a chronic physical health problem. Recently a report compared acupuncture or counselling with usual care alone for 755 patients with depression complicated with pain. They found that at 3 months, both acupuncture and counselling interventions were effective for depression compared to usual care alone whether there was pain or not. Patients in the pain group had greater reductions in both depression symptoms with acupuncture from baseline to 3 months than those who received counselling or usual care. All treatment options were effective in reducing pain between baseline and 3-month follow-up after controlling for baseline pain, however, acupuncture delivered a greater degree of pain relief than counselling or usual care in the short-to-medium term. Reductions in both depression and pain were most marked in the acupuncture group, followed by the counselling group and then the usual care group.
Acupuncture is effective for muscle pain
Muscle pains are common and can involve more than one muscle. Muscle pain also can involve ligaments, tendons, and fascia, the soft tissues that connect muscles, bones, and organs. Muscle pain is most frequently related to tension, overuse, or muscle injury from exercise or physically-demanding work. In these situations, the pain tends to involve specific muscles and starts during or just after the activity. It is usually obvious which activity is causing the pain. Trapezius muscle is a large superficial muscle that extends longitudinally from the skull to the upper back and laterally to the shoulder blade. Its functions are to move the scapulae and support the arms. These muscles are usually overused and painful due to much stress and improper postures.
Acupuncture is a useful tool to release trapezius muscle pain. There were 20 women aged ranging from 18 to 40 years with upper trapezius muscle pain for average 5.55 years. They were treated with acupuncture After 9 sessions of acupuncture treatments, a reduction in pain intensity was observed on the upper trapezius muscle on both sides. The Pain pressure threshold increased significantly on both sides at the end of the treatment. A significant increase in the electromyography values of the trapezius during isometric contraction was observed at the end of treatment.
Acupuncture for myofascial pain
Myofascial pain syndrome (MPS) refers to pain and inflammation in the body’s soft tissues. This is a chronic condition that affects the fascia which is connective tissue that covers the muscles. Myofascial pain syndrome may involve either a single muscle or a muscle group. The person experiences pain either in the area where the pain originated or in other area where is far from the pain originated. Myofascial pain is mainly caused by injury such as injury to the muscles, excessive strain on a particular muscle or muscle group, ligament or tendon, or injury to muscle fibers. Other causes include repetitive motions or lack of activity. The symptoms of myofascial pain include pain with tender points. The pain can be worse with activity or stress. Pharmacological therapies include anti-inflammatory drugs, antidepressants, and muscle relaxants. Acupuncture can help reduce pain and inflammation to treat myofascial pain. Acupuncture has been widely used for acute or chronic pain management.
Why can acupuncture treat myofascial pain?
In TCM theory, the entire human body is composed of sophisticated interconnected inner systems, which there is an “energy (Qi)” that flows through “meridian (or channels)” in each organ. When the flow of Qi is blocked, pain occurs. By inserting and appropriate manipulating a needle into some points, the channel could be unblocked, thereby reestablishing the free and normal flow of Qi and relieving the pain. Most acupoints are located along one of these channels (some are exceptional).
Recent research has shown that acupuncture has analgesic effect. Acupuncture at one hand acupoint induced a gradual increase in skin pain threshold. Acupuncture induces endogenous opiates release from the pituitary gland into plasma and cause analgesia in the central nerve system. Acupuncture releases neuropeptides inhibiting the primary sensory neurons in the spinal cord. These substances also help reducing inflammation and reducing inflammation response.
Acupuncture is for chronic musculoskeletal pain, which acupuncture points are more effective?
Chronic musculoskeletal pain (CMP) is very common which happens to one in four people. More and more people used acupuncture for pain relief for CMP. If you do choose acupuncture, you need to know that there is diverse usage of acupuncture points for pain relief. Commonly, a combination of local and distant points is used. However, the difference between the effects of local and distant point stimulation is not clear. Recently a review investigated this subject. They studied a difference in effects between stimulating local and distant points, and the combination of both when compared with either alone. Nineteen were included in the qualitative analysis and 15 in the meta-analysis. Local and distant point stimulation was more effective than their respective controls in pain reduction immediately after treatment. Three studies directly compared the stimulation of local and distant points and found no significant difference between the two. No studies compared combined local and distant point stimulation with either alone. Subgroup analyses showed that, local tender point stimulation was more effective than local acupuncture points. Local and distant point stimulation induces similar degree of acupuncture analgesia. The benefit of combining local and distant point stimulation is unknown. However, subgroup analyses suggested that local tender points could be important in the treatment of CMP for short-term pain relief.
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Tan MG et al Ann Acad Med Singapore (2013) 42:133-7
Vikers AJ et al Arch Intern Med (2012) 10:1-10
Mao et al Prim Care (2010) 37:105-117
MacPherson et al PLOS ONE (2013) 8:e77438
J Am Board Fam Med (2013) 26:692-700
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Welcome to my blog
Acupuncture specialist for Fertility, Facial rejuvenation, Pain relief.
Based at Kensington and Harley Street Central London.Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Over 25 year research and clinical experiences
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I have many year clinical experiences. Over the years of practicing, I have developed unique treatment approaches for infertility, skin aging, acne, vulvodynia, neck pain, headache, migraine, shoulder pain, back pain, fatigue, hot flushes, Parkison's disease etc to achieve best treatment results. My devotion and skills are highly praised by my patients. These are examples that my patients say.
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