Category: Pain

The latest NICE guideline on treatment of chronic pain, recommends acupuncture, exercise or psychological therapies, as non-pharmacological approaches to managing chronic primary pain. By contrast, paracetamol, non-steroidal anti-inflammatories and opioids, are not recommended.

The NICE committee which devised the guideline acknowledged that there is now a large evidence base for acupuncture’s short term effectiveness. They cited 27 studies showing it reduced pain and improved quality of life for up to three months.

(Chronic pain (primary & secondary) in over 16s: assessment of all chronic pain & management of chronic primary pain. NICE guideline [NG193], 7 April 2021.)

US military veterans who have acupuncture before surgery, report less pain and need far fewer opioids to manage their discomfort. In the randomized, controlled study presented at the 2020 annual meeting of the American Society of Anesthesiologists, the veterans were also more satisfied with their pain control.

“Six percent of patients given opioids after surgery become dependent on them, and veterans are twice as likely to die from accidental overdoses than civilians,” said Brinda Krish, D.O., lead author of the study and an anesthesiology resident at Detroit Medical Center. “Clearly it is crucial to have multiple options for treating pain, and acupuncture is an excellent alternative. It is safe, cost effective and it works.”

Researchers treated two groups of patients at the John D. Dingell VA Medical Center in Detroit. One group due for hip replacement were randomly assigned to either acupuncture or a control group before surgery. The other included patients undergoing a variety of procedures (including gallbladder removal, hernia repair, hysterectomy or prostate surgery); these were also randomly assigned to either acupuncture or a control group before surgery.

In the first group, patients who had not received acupuncture consumed nearly three times as much morphine in the first 24 hours after surgery, as those who had the treatment. Acupuncture patients reported less pain and 14% reported less anxiety.

In the second group, acupuncture patients consumed only half as many opioids as those in the control group. Only 3% reported nausea and vomiting after surgery, compared to 38% of the control group.

(American Society of Anesthesiologists 2020 Annual Meeting News.)

A large systematic review by researchers in the US, China and the University of Oxford, shows acupuncture should be given for at least five weeks in order to achieve 80% of maximum analgesic effect. A total of 77 randomised trials of acupuncture for chronic pain of the shoulder, neck, knee and lower back were included. They covered 8830 patients. Higher initial pain intensities were found to result in higher acupuncture pain relief.

(The response-time relationship and covariate effects of acupuncture for chronic pain: A systematic review and model-based longitudinal meta-analysis.European Journal of Pain, 13 June 2020.)

American researchers say acupuncture helps diabetic peripheral neuropathy, and is a valuable adjunctive treatment for low income and marginalised sections of society. In a 12 week randomised trial, 40 patients, mean age 59, were recruited from outpatient clinics at the Zuckerberg San Francisco General Hospital and Trauma Center, an urban public hospital serving diverse patients (70% racial/ethnic minorities). In-depth qualitative interviews were conducted with a subset of 17 participants.

Patients randomised to receive acupuncture reported greater decreases in pain compared with usual care, and improvements in quality of life. There was also reduced reliance on analgesics, improved sleep and daily function, reduced stress, and improved engagement with their own self-care.

The authors say,”Overall, participants found acupuncture beneficial for a range of symptoms common with PDN, including burning or aching pain, sensations of heat or cold, or numbness. This diversity of presentations partially explains why conventional treatments such as pain medications have limited efficacy in treating this condition. Acupuncture may hold unique promise as a treatment for PDN because of its potential to address patients’ multifaceted pain experience, including physical symptoms as well as psychological well-being.”

(“It Gave Me Hope” Experiences of Diverse Safety Net Patients in a Group Acupuncture Intervention for Painful Diabetic Neuropathy. Health Equity, online 22 May 2020.)

Acupuncture helps trigeminal neuralgia, and appears a more effective, safer and cheaper option compared with either drugs or surgery, according to research by the School of Medical Sciences, Bangor University. They surveyed 17 studies comparing the drug carbamazepine, with microvascular decompression surgery, and with acupuncture.

Acupuncture had the highest efficacy at 86%, compared with 79% for medication and 72% for surgery. It also had the lowest side-effect rate at 23%, compared with 25% for surgery and 89% for medication. The medication cost twice as much as acupuncture, and surgery cost more than six times as much. Patients also rated acupuncture the least stressful option.

(Acupuncture in the management of trigeminal neuralgia. Acupuncture in Medicine, 10 June 2020.)