Traditional Chinese Medicine and the Treatment of Pain

A joint position stand of the Living Younger Longer Institute and the Colorado School of Traditional Chinese Medicine

This pronouncement was prepared by Joseph Brady M.S.T.C.M. Dipl. O.M. of the Living Younger Longer Institute and reviewed by Britney Chowning, Vladimir DiBrigida L. Ac., Mark Manton L.Ac. Dipl. Ac& OM, Jeannette Hoyt

Rationale

With increasing rates of drug addiction, overdoses and deaths from abuse of opioid drugs health care practitioners must consider safer alternatives in the treatment of pain. The Joint Commission which accredits and certifies nearly 21,000 health care organizations revised the rationale in the treatment of pain using an extensive literature review, and feedback from clinical experts in the treatment of pain, the Commission recommendations affirmed that treatment strategies should consider both pharmacologic and nonpharmacologic approaches such as acupuncture.


The Joint Commission On line, A complimentary publication of The Joint Commission November 12, 2014.

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 the treatment of pain particularly, 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 provides better pain relief than oxycodone or tramadol
Number Needed To Treat (NNT) Score

Acupuncture NNT from Archives of Internal Medicine meta-analysis

(A lower number means better pain relief)

  • Acupuncture NNT = 4.13
  • Oxycodone NNT = 4.6
  • Tramadol NNT = 8.3

National Safety Council
(http://www.nsc.org/RxDrugOverdoseDocuments/900006585_ADV_NNT_Infographic.pdf)

Acupuncture Analgesia in Surgery

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.

Biological Plausibility

Modern research into the neurophysiological mechanism of action has yielded much in understanding how acupuncture relieves pain. Physiological and imaging studies suggest that acupuncture triggers the release of endogenous opioid-like substances, including enkephalin, endorphin, dynorphin and endomorphin. Studies demonstrate that the limbic system plays an important role in acupuncture-induced analgesia. Studies have found that only acupuncture stimulation with De Qi sensation activated the hypothalamus. “De Qi” sensation is frequently described by patients as soreness, numbness, tingling, ache, fullness, or warm sensation that is achieved during manipulation of the acupuncture needles. Future studies will continue to shed light into the mechanisms of this ancient pain control technique (Acupuncture analgesia: I. The scientific basis. ANESTHESIA & ANALGESIA, Vol. 106, No. 2, February 2008), http://bja.oxfordjournals.org/content/115/2/183.abstract, Perioperative Acupuncture and Related Techniques Anesthesiology. 2005 May; 102(5): 1031–1078. Grigory V. Chernyak, M.D.* and Daniel I. Sessler, M.D.

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.)

Adverse effects

Although acupuncture is technically an invasive procedure injury is extremely rare 1.1 in 10,000 treatments. Highly trained practitioners can prevent most problems, and the use of single-use disposable needles has eliminated cross infection. The most common complication is syncope or pre-syncope (the so-called needle shock reaction). In most cases, removal of the needle and performing the technique in the recumbent rather than the sitting position is enough to prevent this.
Hugh MacPherson, research director, Kate Thomas, deputy director, Stephen Walters, lecturer in medical statistics,c and Mike Fitter, research consultantants., BMJ. 2001 Sep 1; 323(7311): 486–487. The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturists

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