Relieving Pain with Acupuncture

Studies Show that Needling Works, But Scientists Don’t Know Why

Sep 15, 2009 Stephen Allen Christensen

Chinese physicians have practiced acupuncture for millennia, believing the technique improves the flow of energy, or "qi," through diseased areas of the body.

For many years, Western doctors eschewed the use of acupuncture for pain control, believing that its benefits (if any) derived from a “placebo effect.” Now, some American physicians are acquiring skills in this ancient practice because recent scientific evidence supports what traditional acupuncturists have claimed for centuries.

Over a decade ago, the National Institutes of Health conceded that acupuncture was effective for treating postoperative dental pain, but the NIH consensus panel failed to extend its recommendations to other types of pain. (National Institutes of Health. NIH Consensus Statement: Acupuncture. 1997, Volume 15, No. 5)

Western physicians and researchers have been wary of any studies that compared acupuncture with more accepted methods for treating pain.Their reticence stemmed from the difficulties encountered with blinding the trials (i.e., preventing subjects from knowing whether they were getting real or sham acupuncture), uncertainties about what constituted adequate therapy, and – perhaps most telling – the lack of clarity about acupuncture’s physiologic effects.

During the past decade, however, enough evidence-based information has accumulated to allow even the most dogmatic physician to acknowledge acupuncture’s role in treating certain conditions.

Traditional Perceptions of Acupuncture

Practitioners of traditional Eastern medical disciplines believe that pain arises from stagnation or blockage of the normal flow of energy (“qi” [pronounced “chee”]) through the affected area.

Acupuncture opens “channels” and helps restore the flow of energy from centers of force (“chakras”) through the various organ systems of the body.

This philosophy, which flies in the face of the allopathic model of disease management, has contributed to delays in American doctors’ acceptance of acupuncture as a viable therapeutic modality.

Scientific Evidence Supports the Use of Acupuncture for Certain Kinds of Pain

Randomized clinical trials (RCTs) now support the use of acupuncture for the following pain syndromes:

Chronic Low Back Pain

• One meta-analysis of multiple RCTs showed that acupuncture effectively relieves chronic low back pain, but that it is not any more effective than other “active” therapies. (Manheimer E, et al. Meta-analysis: acupuncture for low back pain [published correction appears in Ann Intern Med. 2005;142(11):950-951]. Ann Intern Med. 2005;142[8]:651-663)
• However, another large trial demonstrated that adding acupuncture to routine care for low back pain not only led to dramatic improvement; it did so in a remarkably cost-effective manner. (Witt C, et al. Pragmatic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain. Am J Epidemiol. 2006;164[5]:487-496)

Headache

• RCTs have demonstrated the effectiveness of acupuncture for treating migraines, chronic idiopathic daily headaches, and chronic tension-type headaches.
• Cochrane systematic reviews show benefit from acupuncture for treating both chronic tension-type headaches and migraines. (Linde K, et al. Acupuncture for tension-type headache. Cochrane Database Syst Rev. 2009;[1]:CD007587 and Linde K, et al. Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev. 2009;[1]:CD001218)

Chronic Neck and Shoulder Pain

• Several RCTs have demonstrated the utility and cost-effectiveness of acupuncture for treating chronic neck and shoulder pain syndromes; indeed, aside from low back pain, these types of pain are the most common reasons patients try acupuncture.
• One Cochrane review showed that using acupuncture for neck pain is more effective than sham acupuncture treatments, so-called “inactive treatments,” or simply waiting to see if patients improved. (Trinh K, et al., for the Cervical Overview Group. Acupuncture for neck disorders. Cochrane Database Syst Rev. 2006;[3]:CD004870)
• Another review evaluating acupuncture for shoulder pain concluded that data is insufficient (but promising) to recommend acupuncture. (Green S, et al. Acupuncture for shoulder pain. Cochrane Database Syst Rev. 2005;[2]:CD005319)

Arthritis

• When compared to sham acupuncture or patient education alone, appropriately performed acupuncture leads to significant improvement in pain and joint function in patients with osteoarthritis of the knee. (Berman B, et al. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med. 2004;141[12]:901-910)
• Current evidence does not support the use of acupuncture for relieving the pain associated with rheumatoid arthritis.

Other Pain Syndromes

• High-quality RCTs have demonstrated benefit from acupuncture in the treatment of fibromyalgia, temporomandibular joint (TMJ) pain, tennis elbow, labor pains, discomfort due to irritable bowel syndrome, menstrual cramps, cancer pain, and chronic pelvic pain.
• However, data is insufficient to provide practice recommendations regarding the use of acupuncture for these conditions.

Acupuncture is safe, well-tolerated, and – increasingly – of proven benefit for a variety of painful conditions. Individuals hoping for benefits beyond (or instead of) those afforded by accepted Western modalities should be reassured that acupuncture is a useful approach to pain management.

The copyright of the article Relieving Pain with Acupuncture in Natural Medicine is owned by Stephen Allen Christensen. Permission to republish Relieving Pain with Acupuncture in print or online must be granted by the author in writing.

Acupuncture Chart Showing the Fourteen Meridians

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