The time has come for mainstreaming alternative therapies for pain. Even some insurance companies are attempting to turn the tide from using opioids as first-line pain therapy. This headline appeared on the Blue Cross Blue Shield website on March 29, 2018:
Blue Cross Blue Shield Association [BCBS] Affirms Opioids Should Not Be Prescribed as First or Second Lines of Pain Therapy.
Professional standards require alternative therapies designed to limit harm to Blue Cross and Blue Shield members.
Dr. Harrold Paz, MD, MS is Executive VP and Chief Medical Officer for Aetna and author of Finding Solutions, Aetna’s Comprehensive Strategy to Fighting the Opioid Epidemic. He took the BCBS article a step further by stating this about opioid drug strategy:
One of the best ways to stop misuse and abuse is to find alternatives to opioids from the start. A recent study found that mindfulness exercise was more effective than opioids in treating chronic back pain. For some, alternative approaches may include acupuncture, massage therapy or chiropractic treatment. We’re working hard to promote these and other treatments for chronic pain management that do not rely on opioids.
Two-thirds of our military hospitals seem to agree:
In 2009, former Army Surgeon General Dr. Eric Schoomaker chartered a task force to re-evaluate the Army’s approach to pain, which had centered on opioids. The focus was understandable — “nobody who has his leg blown off screams for acupuncture,” said Schoomaker . . . But he added there was also openness to acupuncture and other approaches among soldiers and sailors who, while overseas, had tried non-drug approaches for chronic pain. Schoomaker said he was inspired to seriously consider alternative approaches by his wife, a yoga instructor.
Now two-thirds of military hospitals and other treatment centers offer acupuncture, according to a recent study.
The military’s openness to alternatives is “because the need is so great there,” said Emmeline Edwards of the National Center for Complementary and Integrative Health, a federal scientific research agency. “Perhaps some of the approaches have been used without a strong evidence base. They’re more willing to try an approach and see if it works.
The evidence supports acupuncture treatment for pain. Part 1 of this series highlighting my recent research, discussed the 2017 Mac Pherson et al meta-analysis of patients with chronic pain, published in Pain. The group reviewed 29 trials totaling 17,922 patients with various pain conditions. Part 2 of this series examines Cochrane review articles, large randomized control trials (RCT) and systemic reviews supporting acupuncture for specific pain conditions: neck pain, low back pain, elbow pain, TMJ and gyn pain.
Acupuncture for Neck Pain
How does acupuncture stack up for common pain conditions? In 2016, Trinh et al published the Cochrane review Acupuncture for neck disorders “To determine the effects of acupuncture for adults with neck pain, with focus on pain relief, disability or functional measures, patient satisfaction and global perceived effect”. The Cochrane research group, in Canada, is considered the gold standard of mega-analysis. Mega-analysis reviews high-quality data of a large body of RCTs on the subject of interest. In this way, large numbers of studies and thousands of patient outcomes are pooled to see if results are repeatable and to get the overview of efficacy of treatment. The Cochrane Group has studied acupuncture for many types of chronic pain conditions, including headache/migraine and neck pain. Trinh et al found
Of the 27 included studies, three represented individuals with whiplash-associated disorders (WADs) ranging from acute to chronic (205 participants), five explored chronic myofascial neck pain (186 participants), five chronic pain due to arthritic changes (542 participants), six chronic non-specific neck pain (4011 participants), two neck pain with radicular signs (43 participants) and six subacute or chronic mechanical neck pain (5111 participants). For mechanical neck pain, we found that acupuncture is beneficial at immediate-term follow-up compared with sham acupuncture for pain intensity; at short-term follow-up compared with sham or inactive treatment for pain intensity; at short-term follow-up compared with sham treatment for disability; and at short-term follow-up compared with wait-list control for pain intensity and neck disability improvement.
What about safety and cost of treatment? “Acupuncture appears to be a safe treatment modality, as adverse effects are minor… acupuncture treatments were cost-effective.”
As you can see in this video demonstration of my neck pain treatment with immediate results, patients are pleased with quick pain relief.
Acupuncture for Low Back Pain
The most common pain complaint is back pain. 80% of adults experience low back pain at some point in their lives. I certainly have. In 2007 Yao-chi et al ran an RCT study of 300 patients receiving electroacupuncture (EA: wires are connected to the needles and stimulated with a battery pack) for acute lumbar sprain. The researchers re-evaluated patients at 1 week and 1-month intervals. The control group received drugs.
In the short-term, the effective rate was 97.3% in the EA group and 89.2% in the medication group (p<0. 01). In the long-term, the effective rate was 99.3% in the EA group and 93.2% in the medication group (p<0. 01). The researchers concluded that both the short-term and the long-term therapeutic effects of electroacupuncture at the acupoint SI 3 on acute lumbar sprain are better than those of medication.
In 2007, Haake et al designed a 3-arm, double-blind RTC involving 340 outpatient practices in Germany. The RTC included 1162 patients aged 18 to 86 years with a history of chronic low back pain for a mean of 8 years. Patients underwent ten 30-minute sessions, generally 2 sessions per week, of verum acupuncture (n = 387) according to principles of traditional Chinese medicine; sham acupuncture (n = 387) consisting of superficial needling at non-acupuncture points; or conventional therapy, a combination of drugs, physical therapy, and exercise (n = 388). Five additional sessions were offered to patients who had a partial response to treatment (10%-50% reduction in pain intensity). The primary outcome was response after 6 months.
Low back pain improved after acupuncture treatment for at least 6 months. The effectiveness of acupuncture, either verum or sham, was almost twice that of conventional therapy.
Acupuncture for Elbow Pain
In their 2004 systematic review, Trinh et al observed, “Lateral epicondyle pain is a common complaint in North America. In the past 10 years, acupuncture has become increasingly recognized as an alternative treatment for pain, including epicondyle pain”. The research showed
All the studies suggested that acupuncture was effective in the short-term relief of lateral epicondyle pain. Five of six studies indicated that acupuncture treatment was more effective compared to a control treatment.
There is strong evidence suggesting that acupuncture is effective in the short-term relief of lateral epicondyle pain.
Acupuncture for TMJ Pain
In 2010, Cho and Whang demonstrated acupuncture efficacy for TMJ in their systematic review of 19 studies, 856 patients. Using the Cochrane criteria, the authors compared acupuncture to placebo, splints, PT, vitamin B1, and wait-list controls. Of note, four trials, 397 patients, showed acupuncture more effective than physical therapy. “This systematic review noted moderate evidence that acupuncture is an effective intervention to reduce symptoms associated with TMD.”
Acupuncture for Gynecological Pain
In 2008, a German group, Witt et al, ran an RTC of 650 women with menstrual pain. The acupuncture group received 15 treatments over 3 months, compared to a no treatment control. All were allowed usual care (drugs). The acupuncture group had less pain (3.1 vs 5.4 on a 1-10 scale) and better quality of life than the control. The researchers found acupuncture was cost-effective.
So you can see here that evidence supports acupuncture for treating numerous pain conditions. In my clinical practice, I find it rare when pain does not respond to acupuncture. Generally only in complicated conditions, especially involving surgeries. In my experience, any type of pain responds to acupuncture: chronic, injuries, muscular, joints, arthritis, post-surgical pain, and internal – abdominal and gynecology. I discuss treatment for many pain conditions on my website www.BartlettAcupuncture.com. In the third article in this series, I will review the data for two widely researched conditions: headaches and osteoarthritis.