An Integrative Approach to Chronic Pain Management

August 26, 2019 Joe Brady

Prompted by a call from the National Academy of Medicine for improved national data on pain, a recent study provides new insights concerning pain trends and opioid use for pain management.

41% of U.S. Adults Suffering From at Least One Painful Health Condition

Researchers showed that the number of U.S. adults suffering from at least one painful health condition increased substantially from 120.2 million (32.9 percent) in 1997/1998 to 178 million (41 percent) in 2013/2014. Furthermore, the use of strong opioids, like fentanyl, morphine, and oxycodone, for pain management among adults with severe pain-related interference more than doubled from 4.1 million (11.5 percent) in 2001/2002 to 10.5 million (24.3 percent) in 2013/2014. These are the findings of a comprehensive study, conducted by the National Center for Complementary and Integrative Health was published in the Journal of Pain. Although opioid use is also way up there are alternatives in chronic pain management. Read on to learn how to relieve pain naturally.

Use of Opioids for Pain Management Increases

“The data show a substantial increase not only in the number of U.S. adults with painful health conditions, but also in overall use of opioids and in the number of people receiving multiple opioid prescriptions,” says Helene Langevin, M.D., NCCIH director. “This long-term picture of pain management is of critical importance as NIH addresses the opioid crisis. It offers insights that can help improve decision-making by stakeholders—from patients and providers to payers and policymakers.”

Reference Read the Article https://nccih.nih.gov/news/press/02122019

Nahin RL, Sayer B, Stussman BJ, Feinberg TM. Eighteen-year trends in the prevalence of, and health care use for, noncancer pain in the United States: Data from the Medical Expenditure Panel Survey (link is external)
. Journal of Pain. January 15, 2019. [Epub ahead of print].

Reframing Pain: Watch the TED Talk

Traditional Chinese Medicine Offers Alternatives in Pain management 

Archives of Internal Medicine:Review of High Quality Clinical Trials

The best review done to date and published in the Archives of Internal Medicine included 29 high quality, randomized controlled trials (RCTs) of acupuncture for chronic pain. This meta-analysis looked at individual patient data on a total of 17,922 patients. and found that acupuncture was superior to both sham and no-acupuncture control for back pain, neck pain, osteoarthritis and headache (P < .001). The review found acupuncture to be effective for the treatment of chronic pain and significant differences between true and sham acupuncture indicate that acupuncture is more than just a placebo and is a reasonable referral option for patients with chronic pain.

Acupuncture for Chronic Pain Individual Patient Data Meta-analysis, Andrew J. Vickers, DPhil; Angel M. Cronin, MS; Alexandra C. Maschino, BS; George Lewith, MD; Hugh MacPherson, PhD; Nadine E. Foster, DPhil; Karen J. Sherman, PhD; Claudia M. Witt, MD; Klaus Linde, MD

Arch Intern Med. 2012;172(19):1444-1453. doi:10.1001/archinternmed.2012.3654.

Acupuncture Analgesia in Surgery

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Perhaps the most dramatic example of acupuncture’s ability to control pain is the use of acupuncture during surgery.  Acupuncture analgesia has been used for battlefield surgery in China since at least 200 A.D. Research shows that acupuncture may be effective in perioperative settings for preoperative sedation, and for postoperative pain relief, nausea and vomiting but requires a high level of expertise by the acupuncture practitioner. (Anesthesiology). Acupuncture anesthesia is even currently being used for open heart surgery in contemporary China and Japan and more generally used for pain during surgical operations, post- operative pain, neuropathic pain, pain associated with teeth extractions. Compared to general anesthesia patients have less usage of narcotic drugs (p<0.001), less postoperative pulmonary infection (p<0.05), shorter stay in intensive care unit (p<0.05), and a lower medical cost (P<0.05). A combined acupuncture-medicine anesthesia strategy reduces the postoperative morbidity and medical costs in patients undergoing open heart surgery and cardiopulmonary bypass. Evid Based Complement Alternat Med. 2008 Jun;5(2):153-8. doi: 10.1093/ecam/nem056. Zhen Ci Yan Jiu. 1992;17(2):87-9.

Read More About Alternatives in Pain Relief

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Harvard Medical School Natural and Alternative Pain Relief

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Applying the Mind to Manage Pain

Acupuncture in the Treatment of Opiate Addiction

Clinical trials are currently underway to determine the effectiveness of acupuncture in the treatment of opioid drug addiction.

http://www.medscape.com/viewarticle/585219_2 Zeng X, Lei L, Lu Y, Wang Z. Treatment of heroinism with acupuncture at points of the Du Channel. J Tradit Chin Med 2005;25:166–70. Zhang B, Luo F, Liu C. Treatment of 121 heroin addicts with Han’s acupoint nerve stimulator. Zhonguo Zhong Xi Yi Jie He Za Zhi 2000;20:593–5.)

Other Modalities for treating Pain used in Traditional Chinese Medicine

Traditional Chinese Medicine uses many other modalities besides acupuncture. One review of 75 studies covering all aspects of TCM in individuals with neck pain or low back pain. This review found that acupuncture, acupressure, and cupping can be effective in the treatment of pain. Other traditional treatments, such as gua sha, tai chi, qigong, and manipulation have also showed good effect and further studies on these treatments are needed.

Traditional Chinese Medicine for Neck Pain and Low Back Pain: A Systematic Review and Meta-Analysis

Qi-ling Yuan,1 Tuan-mao Guo,2 Liang Liu,1 Fu Sun,1,3 and Yin-gang Zhang1,* Jan P. A. Baak, Academic Editor

Tai chi/Qigong and chronic pain.

The Chinese exercise and meditation therapies of Tai Chi and Qigong contribute to chronic pain management. NIH research findings suggest that practicing tai chi may reduce pain from knee osteoarthritis, fibromyalgia and back pain. Less research has been done on the effects of Qigong, but some studies suggest it may reduce pain from fibromyalgia and chronic neck pain. Both also may offer psychological benefits, such as reducing anxiety and improving general quality of life. https://nccih.nih.gov/health/taichi/introduction.htm, Abstract Reg Anesth Pain Med. 2012 Jul-Aug;37(4):372-82. doi: 10.1097/AAP.0b013e31824f6629.

Chinese Herbal Bath Therapy for the Treatment of Knee Osteoarthritis: Meta-Analysis of Randomized Controlled Trials.

15 Randomized trials totaling 1618 subjects showed superior pain improvement using Chinese herbal bath therapy when compared with standard western treatment. Chinese herbal bath therapy may be a safe, effective, and simple alternative treatment modality for knee osteoarthritis. Further rigorously designed, randomized trials are warranted.  (Chinese Herbal Bath Therapy for the Treatment of Knee Osteoarthritis: Meta-Analysis of Randomized Controlled Trials. Evid Based Complement Alternat Med. 2015;2015:949172. doi: 10.1155/2015/949172. Epub 2015 Sep 21. Chen B1, Zhan H1, Chung M2, Lin X1, Zhang M1, Pang J1, Wang C3.)

Acupuncture and moxibustion for lateral elbow pain: a systematic review of randomized controlled trials

A total of 19 RCTs that compared acupuncture and/or moxibustion with sham acupuncture or conventional treatment. Results showed that acupuncture or moxibustion was superior or equal to conventional treatment, such as local anesthetic injection, local steroid injection, non-steroidal anti- inflammatory drugs, or ultrasound. Six low quality RCTs showed that acupuncture and moxibustion combined was superior to manual acupuncture alone and better quality randomized trials are needed.

BMC Complement Altern Med. 2014; 14: 136. Published online 2014 Apr 12. doi:  10.1186/1472-6882-14-136

Acupuncture and moxibustion for lateral elbow pain: a systematic review of randomized controlled trials

Marcus Gadau,#1,8 Wing-Fai Yeung,#2 Hua Liu,3 Chris Zaslawski,4,8 Yuan-Sheng Tan,5,8 Fu-Chun Wang,6,8 Sergio Bangrazi,7,8 Ka-Fai Chung,2 Zhao-Xiang Bian,1 and Shi-Ping Zhang1,8

Massage Therapy

A meta-analysis of fifteen RCTs found moderate evidence of massage therapy on improving pain in patients with neck pain compared with inactive therapies and limited evidence compared with traditional Chinese medicine. High quality RCTs are needed to confirm these results. Efficacy of Massage Therapy on Pain and Dysfunction in Patients with Neck Pain: A Systematic Review and Meta-Analysis Yong Hong Cheng1,2 and Gui Cheng Huang1 Evidence-Based Complementary and Alternative Medicine Volume 2014 (2014), Article ID 204360, 13 pages http://dx.doi.org/10.1155/2014/204360