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The Journal of Chinese Medicine And Acupuncture Volume 21 Issue 2 September 2014 P9
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The Journal of Chinese Medicine And Acupuncture Volume 27 Issue 2 November 2020 P9
Thursday, 31 July 2014
Why live with pain? acupuncture helps to have pain free.
Acupuncture is called ancient art and has been used in Asia for centuries to treat many conditions and relieve pain. It is now being recognised in western countries, such as USA and European countries. It is used to ease back pain, nerve pain and other pain conditions.
If a pain last over 3 month, it is chronic. Chronic pain is a common condition. It can occur in many places such as low back pain, neck pain, headache, migraine and knee pain. Chronic pain in the muscles and joints can make life miserable. Many simple treatments like ice and heat, anti-inflammatory medications, physical therapy, and appropriate exercises can often ease the pain. If these methods don’t work, not everyone is able or willing to take pain medication every day, and not everyone can or should have surgery for painful conditions.
Chronic pain is very common and difficult to manage. Apart from pain killers, acupuncture is well accepted to treat chronic pain conditions. Complementary and alternative medicine (CAM) plays an important role to reduce pain and improve quality of life for those who suffer from chronic pain. A survey by MG Tan et al from Singapore studied the use of CAM in chronic pain patients in Singapore. They found that 84% of patients used CAM at some point of their life. 30% of patients used CAM for other reasons instead of chronic pain. 35% of patients used for both pain and non pain conditions. Acupuncture was the most utilised which is 49%, followed by Chinese herbs (18%), Tui Na (17%) and massage (16%). Many patients were on more than one form of the CAM. 72% patients thought that CAM helped with their pain. 26% patients used CAM because conventional medicine did not work. 38% thought it was safer and had fewer side effects. 24% of patients thought it was cheaper. 85% of patients were satisfied. Many patients did not discuss the use of CAM with their doctor, mainly because they thought that CAM is more natural and safe.
Acupuncture has little side effects and well tolerated. A survey from people accepted acupuncture treatment has shown that 46% said acupuncture helped greatly, 26% said it helped in some degree and 28% said there was little help. Research showed that lower back pain is the most common reason for visiting acupuncturists. Usage of acupuncture has increased enormously in recent 10 years.
Recently, Mao et al reviewed clinical research of a few chronic pain condition treatments with acupuncture including lower back pain, knee pain, neck pain and headache. Low back pain is the most common reason for visits to acupuncturists. Recent 10 years, using high quality randomized controlled trials study acupuncture has increased enormously. Most of them have shown that acupuncture treatment is effective to lower back pain and it is better than no treatment or equivalent to other conventional treatments. The situation of knee pain with acupuncture treatment is pretty similar to lower back pain which is acupuncture is better than no treatment. For neck pain treatment with acupuncture some controlled trials suggested that acupuncture is better than or equivalent to physiotherapy. Some study suggested that acupuncture is better than massage and dry needling in motion-related neck pain. In a study on headache, it showed that acupuncture reduced headache frequency and severity, and at the same time it also improves headache related quality of life. There is a review about acupuncture for chronic pain by Vickers AJ et al just published in Arch Intern Med (2012). They analysed 29 clinical randomized controlled trials involving in 17922 patients to investigate the effect of acupuncture for 4 chronic pain conditions: back and neck pain, osteoarthritis, chronic headache and shoulder pain. In the primary analysis, including all eligible trials, acupuncture was superior for both sham and no acupuncture control for each pain condition. After exclusion of an outlying set of trials that strongly favoured acupuncture, the effect sizes were similar across pain conditions analysed. Patients receiving acupuncture had less pain. They concluded that acupuncture is effective for the treatment of chronic pain and it is more than a placebo. Acupuncture is clearly a treatment option.
It becomes general knowledge that acupuncture releases pain effectively. However the effectiveness of acupuncture for pain relief is still coming up for debate and there are always some clinical trials showing lack of effect compared with control. What is the reason for this? Macpherson et al analysed clinical trials involving patients with headache and migraine, osteoarthritis, and back, neck and shoulder pain. There were many different types of controls used in the trials including sham controls such as non-needle sham, penetrating sham needles and non-penetrating sham needles and non sham control such as non-specified routine care and protocol-guided care. They analysed the impact of choice of control on effect of acupuncture. They found that acupuncture was significantly superior to all categories of control group. For trials that used penetrating needles for sham control, acupuncture had smaller effect sizes than for trials with non-penetrating sham or sham control without needles. Large effects of acupuncture were seen after exclusion of outlying studies. In trials with non-sham controls, larger effect sizes associated with acupuncture vs. non-specified routine care than vs. protocol-guided care. From this study it can be seen that acupuncture is significantly superior to control irrespective of the subtype of control. Penetrating needles can have positive effects which should be avoided as a control in the study.
Recently a study analysed 29 clinical trials involved in 17922 patients with chronic pain treated with acupuncture. This study suggested that acupuncture is effective for the treatment of chronic pain including back and neck pain, osteoarthritis, and chronic headache and acupuncture is a reasonable option. There is scientific evidence how acupuncture works. Many research suggested that acupuncture relives pain by affecting neurotransmitters, hormone levels, or the immune system.
Why can acupuncture be used to relive pain?
Acupuncture can act as a pain killer and it is used in many conditions and helps relieve pain. The mechanism is studied by modern research. Studies have shown that pressure pain threshold is increased after acupuncture treatment. The effect could be long-term and short-term. Studies have also shown that acupuncture reduced sensitivity to noxious thermal stimuli which could be mechanical (such as pinching or tissue deformation), chemical (such as exposure to acid or ittitant) or thermal (such as high or low temperature). Sensory threshold changes were equally frequent reported after manual acupuncture as after electroacupuncture. Acupuncture affects sensory perception. Results are most convincing for the pressure pain threshold, especially in pain conditions associated with tenderness.
Acupuncture for myofascial pain
Myofascial pain syndrome (MPS) refers to pain and inflammation in the body’s soft tissues. This is a chronic condition that affects the fascia which is connective tissue that covers the muscles. Myofascial pain syndrome may involve either a single muscle or a muscle group. The person experiences pain either in the area where the pain originated or in other area where is far from the pain originated. Myofascial pain is mainly caused by injury such as injury to the muscles, excessive strain on a particular muscle or muscle group, ligament or tendon, or injury to muscle fibers. Other causes include repetitive motions or lack of activity. The symptoms of myofascial pain include pain with tender points. The pain can be worse with activity or stress. Pharmacological therapies include anti-inflammatory drugs, antidepressants, and muscle relaxants. Acupuncture can help reduce pain and inflammation to treat myofascial pain. Acupuncture has been widely used for acute or chronic pain management.
Why can acupuncture treat myofascial pain?
Recent research has shown that acupuncture has analgesic effect. Acupuncture at one hand acupoint induced a gradual increase in skin pain threshold. Acupuncture induces endogenous opiates release from the pituitary gland into plasma and cause analgesia in the central nerve system. Acupuncture releases neuropeptides inhibiting the primary sensory neurons in the spinal cord. These substances also help reducing inflammation and reducing inflammation response.
Hopton A BMJ Open (2014) 4:e004964
Macpherson H et al PLoS One (2014) 9:E93739
Tan MG et al Ann Acad Med Singapore (2013) 42:133-7
Vikers AJ et al Arch Intern Med (2012) 10:1-10
Mao et al Prim Care (2010) 37:105-117
MacPherson et al PLOS ONE (2013) 8:e77438
J Am Board Fam Med (2013) 26:692-700
Aranha et al Rev Bras Fisioter (2011) 15:371-9
Chou LW et al Evid Based Complement Alternat Med (2012) 2012:705327
Wong Lit Wan D et al Eur J Pain (2015) Feb 17. doi: 10.1002/ejp.671. [Epub ahead of print]
Bastos JL et al J Acupunct Meridian Stud (2013) 6:163-8
Iannuccelli C et al Clin Exp Rheumatol (2012) 30:112-6
Baeumler PI et al PLoS One (2014) 9:e113731
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