Category Archives: Acupuncture for pain

Study showing acupuncture to be superior to morphine in the emergency room

Here’s an article from Apple News outlining the superior efficacy of acupuncture over morphine carried out in 300 emergency departments. This adds to the building evidence supporting the efficacy of acupuncture in the treatment of acute and chronic pain.

 

“Many people are quick to dismiss the power of alternative therapies to cure pain and suffering, as is the case with acupuncture. But with science now saying otherwise, people may have to reevaluate their opinions.

An excellent case in point is a new study published in the American Journal of Emergency Medicine. The study, which was published in July of this year, compared acupuncture against morphine in the management of acute pain.

Researchers randomly selected 300 emergency departments and split them into two even groups. The first group was subjected to acupuncture in order to treat their acute pain, while the second group was given morphine.

The results were even better than researchers imagined. Patients who were treated with acupuncture experienced a whopping 92 percent reduction in their pain, while the morphine group experienced a 78 percent reduction. Not only that, the acupuncture group had a much faster pain recovery time. While the morphine group took an average of 28 minutes to recover from their pain, the acupuncture group recovered from their pain in an average of 16 minutes.

So, the alternative treatment was both more effective in reducing pain and faster. So what’s the catch? There doesn’t appear to be one! Not only did acupuncture blow the conventional medical treatment out of the water on those fronts, it also had fewer drawbacks. Of the one in three patients who experienced adverse side effects from the treatment, 57 percent of these were in the morphine group and just 2.6 percent were in the acupuncture group.

The study went on to suggest that acupuncture “should be considered, especially in today’s increasingly complicated and polymedicated patients, to avoid adverse drug reactions.” Let’s dig a little deeper and find out whether acupuncture really is the better choice for pain treatment in hospitals and ERs.

Morphine and common side effects

Morphine is an opioid (meaning opiate-based) medication used to treat moderate to severe pain. If you’ve ever had to go into the hospital for surgery, chances are you were placed on a strong dose of morphine post-op. After getting my tonsils out when I was 19, I was eased back into the world of the living with a blast of morphine, which left me feeling pretty whacky but largely devoid of pain.

While morphine is undoubtedly effective in alleviating pain, it’s potentially lethal side effects make it a very dangerous drug indeed. In 2014, more than 28,000 Americans died from opioid overdose, with 14,000 of those deaths involving prescription opioids. According to the California Department of Public Health, prescription opioids like morphine were only prescribed for relieving acute pain. Today, however, they’re increasingly being used to treat chronic pain, such as back pain or osteoarthritis. Aside from the addictive nature of morphine, this is putting many people at risk.

The United Kingdom is no better. This article is one of many which highlights the unprecedented number of deaths associated with morphine overdose or side effects under expert supervision in hospitals. The article indicated that three elderly patients in a Portsmouth hospital were killed due to a prescription of lethal doses of morphine, while two other patients in the same hospital died after being administered “suitable” doses of the drug.

More common side effects

When you look at the statistics around morphine, none of this should come as any real surprise. Side effects associated with this opiate are staggering. They are so numerous that I’ll only list a small fraction to give you some idea of just how risky morphine is:

Abdominal pain

Stomach pain

Blurred vision

Bulging soft spot on the head of an infant (I didn’t even know it was legal to prescribe morphine to babies!)

Loss of color in vision

Chest pain

Confusion

Coughing

Reduced urination

Dizziness

Lightheadedness

Fainting

Irregular heartbeat

Headaches

Hives

Rashes

Itching

Nausea

Vomiting

Nervousness

Pounding in the ears

Swelling of the eyelids, lips and tongue

Severe constipation

Shortness of breath

Sweating or chills

Loss of consciousness

Painful urination

Unusual bleeding or bruising

Wow. I for one will never be using morphine again. With such a horrifying list of potential side effects (and that’s certainly not all of them!), I almost think it’d be better to deal with the pain than put that into your body.

What is acupuncture?

Acupuncture is a popular traditional Chinese medicine where thin needles are lightly inserted into the surface of the skin. While it has probably been around for far longer, the first documented utilization of acupuncture dates back to around 100 BCE in ancient China.

Today, acupuncture is receiving something of a revival in the Western world. While many Asian cultures have consistently used acupuncture throughout the past 2,000 or more years, acupuncture was quickly pushed aside in Western cultures with the rise of modern medicine. People began to cast off such traditional treatments in favor of “more effective” aggressively-endorsed medical drugs.

But with an increasing body of evidence showing the dangers and drawbacks of using prescription drugs to treat anything from back pain to migraine headaches, many people are beginning to see the merit in less invasive traditional methods. Acupuncture is now commonly sought out for pain relief, lower back pain, shoulder stiffness and knee problems. Some American physicians prescribe acupuncture treatment in conjunction with conventional medical treatments for improved recovery.

How acupuncture works

Theories as to how acupuncture actually works vary considerably. One major school of thought is that acupuncture operates via neurohormonal pathways. Needles are placed on specific points of the body in order to stimulate certain nerves. These nerves send signals to the brain, which then releases neural hormones such as beta-endorphins. This contributes to feelings of happiness and alleviation of stress, which reduces the pain a patient is feeling.

Another hypothesis is that acupuncture reduces pro-inflammatory markers in the body. Certain studies suggest that acupuncture results in a significant reduction in pro-inflammatory proteins in the body, which decreases inflammation and alleviates pain.

Whatever the reason, the potential side effects of acupuncture are considerably less scary than those of morphine. Listed “side effects” of acupuncture are limited to:

Soreness

Organ injury

Infection

Some people may experience soreness after acupuncture for the first time, but that soreness is from most accounts almost unnoticeable. Both organ injury and infection can occur if the acupuncture practitioner pushes in the needles too deep or doesn’t use new needles each time, respectively. But because the acupuncture practitioners in the United States are closely monitored, this is unlikely to happen.

More acupuncture studies

Aside from the study referenced earlier in this article, there is a huge range of scientific literature validating the claims that acupuncture can alleviate pain. Here are just a few passages from those studies, chosen at random:

“Acupuncture has an intrinsic analgesic (pain relieving) effect in the clinical treatment of tennis elbow pain.” – Journal of Rheumatology, 1993

“Several Cochrane reviews of acupuncture for a wide range of pain conditions have recently been published. All of these reviews were of high quality. Their results suggest that acupuncture is effective for some but not all types of pain.” – Chinese Journal of Integrative Medicine, 2011

“Acupuncture was superior to conventional physical therapy (with regards to chronic back and neck pain).” – Acupuncture and Electro-Therapeutics Research, 1978

“Acupuncture is effective for the treatment of chronic pain and is, therefore, a reasonable referral option.” – Archives of Internal Medicine, 2012

As with everything, keep an open mind and why not give it a go? You might be surprised by the results!

— Liivi HessStruggling with weight problems? Find out why acupuncture might just be that miracle you’ve been hoping for!”

“Time for Acupuncture to Become Part of Standard Care”

The following article by Dr.Lorenzo Cohen, Ph.D., Professor and Director of the Integrative Medicine Program at the University of Texas, MD Anderson Cancer Center appeared in Huffington Post on December 7th, 2013. The article confirms many of the clinical uses for acupuncture in the area of Oncology. These uses are certainly confirmed by myself and other colleagues who have been working in this field utilizing acupuncture and herbal therapy for the past 20 years. Also medical treatment for cancer can easily feel ‘industrial’ and depersonalizing and the care received in acupuncture clinics can help people going through treatment for cancer feel re-empowered, nourished and supported.

In the article the author states that the “mechanisms are not well understood”,  this however is not true any longer with several writers/researchers outlining much of acupuncture’s modes of action in modern scientific understanding. See for example – http://www.amazon.com/Biomedical-Acupuncture-Pain-Management-Integrative/dp/0443066590 and http://www.amazon.com/Introduction-Western-Medical-Acupuncture-1e/dp/0443071772/ref=sr_1_1?s=books&ie=UTF8&qid=1386465583&sr=1-1&keywords=western+acupuncture

Thomas Martin LAc.

See also – http://www.ncbi.nlm.nih.gov/pubmed/23341529

“Acupuncture, the insertion of small, stainless steel needles into points on the body to stimulate specific areas, has been used in recent years by many cancer patients to help with symptom management. Because the mechanisms are not well understood, deciding when and how to safely add acupuncture to one’s treatment plan can be challenging. A recent systematic review conducted by researchers in the Integrative Medicine Program at the MD Anderson Cancer Center can now help patients and their oncologists make more informed choices.

The systematic review, published in the Journal of Clinical Oncology, searched the worldwide literature for randomized, controlled trials evaluating the use of acupuncture for symptom management in cancer patients.[1] Forty-one studies were found for the treatment of eight symptoms (pain — 11, nausea/vomiting — 11, postoperative ileus (constipation) — eight, xerostomia (dry mouth) — four, hot flashes — seven, fatigue — three, anxiety/depression/mood disorders — five, and sleep disturbance — three), and were rated for study quality and whether outcomes were positive or negative.

One well-designed large study undefined for the treatment of chemotherapy-induced nausea and vomiting, found electroacupuncture worked better than anti-nausea medications or sham acupuncture (minimal needling) in women with breast cancer.[2] Although less clear, the evidence also suggests acupuncture is helpful for pain control. None of the identified studies were classified as having a low risk of bias due to study weaknesses, but nine of the 11 pain studies had positive results favoring its use. For the other symptoms assessed, the quality of the studies was lower, but there is reason to believe that with larger more rigorous studies, acupuncture may be found beneficial for some of these conditions as well.

The use of acupuncture for symptom control in oncology is important to consider. Findings from this review and others indicate it is an appropriate treatment alongside conventional care for chemotherapy-induced nausea/vomiting, although additional studies are needed to better understand how it works and which patients might benefit most. For other symptoms, the specific effects of acupuncture remain undetermined, primarily due to weaknesses in the studies. As a low-risk, cost-effective treatment option, acupuncture may be helpful when combined with conventional care for patients suffering from uncontrolled treatment-related side effects or in those for whom other treatment approaches have failed.”

References:

1. Garcia MK, McQuade J, Haddad R, Patel S, Lee R, Palmer JL, Yang P, Cohen L. “Acupuncture in cancer care: a systematic review.” Journal of Clinical Oncology (Published online before print Jan. 22, 2013). doi: 10.1200/JCO.2012.43.5818)

2. Shen J, Wenger N, Glaspy J, Hays RD, Albert PS, Choi C, Shekelle PG. “Electroacupuncture for control of myeloablative chemotherapy-induced emesis: A randomized controlled trial.” JAMA 284:2755-61, 2000.

Acupuncture for migraine and tension headaches

 

I frequently use acupuncture in the treatment of headache of several types such as from tension, neck/shoulder pain and migraine. Generally the response is good and well worth a series of treatments before other more toxic therapies are tried providing there are no serious underlying issues. Efficacy of acupuncture for migraine is also good when added to standard care for this condition which I find is how acupuncture for migraine is usually approached in integrative medical care.

The following are summaries made by researchers – K Linde, G Allais, B Brinkhaus, E Manheimer, A Vickers, A R White – of the Cochrane database, one of the main databases for evidence-based medicine.

The researchers refer to “true” acupuncture as opposed to “fake” or “inadequate” acupuncture. As I have pointed out elsewhere these are misleading distinctions as there’s no absolutely right place to put acupuncture needles. Even so-called fake acupoints can stimulate physiological mechanisms resulting in an acupuncture response.

For an experienced evidence-based acupuncturist any anatomically safe area on the skin may be used for needle placement in a well designed treatment plan. Response may be a little more robust when some of the classical acupoints are used in the treatment plan however. This probably arises from greater sensory nerve concentration in areas near these points making a stronger signal through the nervous system possible.

Thomas Martin LAC

 

 

Acupuncture for tension-type headache

Patients with tension-type headache suffer from episodes of pain which is typically bilateral (affects both sides of the head), pressing or tightening in quality, mild to moderate in intensity, and which does not worsen with routine physical activity. In most patients tension-type headache occurs infrequently and there is no need for further treatment beyond over-the-counter pain killers. In some patients, however, tension-type headache occurs on several days per month or even daily. Acupuncture is a therapy in which thin needles are inserted into the skin at defined points; it originates from China. Acupuncture is used in many countries for tension-type headache prophylaxis – that is, to reduce the frequency and intensity of tension-type headaches.

We reviewed 11 trials which investigated whether acupuncture is effective in the prophylaxis of tension-type headache. Two large trials investigating whether adding acupuncture to basic care (which usually involves only treating unbearable pain with pain killers) found that those patients who received acupuncture had fewer headaches. Forty-seven percent of patients receiving acupuncture reported a decrease in the number of headache days by at least 50%, compared to 16% of patients in the control groups. Six trials compared true acupuncture with inadequate or ‘fake’ acupuncture interventions in which needles were either inserted at incorrect points or did not penetrate the skin. Overall, these trials found slightly better effects in the patients receiving the true acupuncture intervention. Fifty percent of patients receiving true acupuncture reported a decrease of the number of headache days by at least 50%, compared to 41% of patients in the groups receiving inadequate or ‘fake’ acupuncture. Three of the four trials in which acupuncture was compared to physiotherapy, massage or relaxation had important methodological shortcomings. Their findings are difficult to interpret, but collectively suggest slightly better results for some outcomes with the latter therapies.

In conclusion, the available evidence suggests that acupuncture could be a valuable option for patients suffering from frequent tension-type headache.

Acupuncture for migraine headache

Migraine patients suffer from recurrent attacks of mostly one-sided, severe headache. Acupuncture is a therapy in which thin needles are inserted into the skin at defined points; it originates from China. Acupuncture is used in many countries for migraine prophylaxis – that is, to reduce the frequency and intensity of migraine attacks.

We reviewed 22 trials which investigated whether acupuncture is effective in the prophylaxis of migraine. Six trials investigating whether adding acupuncture to basic care (which usually involves only treating acute headaches) found that those patients who received acupuncture had fewer headaches. Fourteen trials compared true acupuncture with inadequate or fake acupuncture interventions in which needles were either inserted at incorrect points or did not penetrate the skin. In these trials both groups had fewer headaches than before treatment, but there was no difference between the effects of the two treatments. In the four trials in which acupuncture was compared to a proven prophylactic drug treatment, patients receiving acupuncture tended to report more improvement and fewer side effects.

Collectively, the studies suggest that migraine patients benefit from acupuncture, although the correct placement of needles seems to be less relevant than is usually thought by acupuncturists.