Welcome to my blog, discover acupuncture with Dr Maggie Ju

Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Many year research and clinical experiences. This blog is for information only.

Friday, 9 February 2018

Having constant pain? Acupuncture can help.

Acupuncture for chronic pain relief

Chronic pain is any pain lasting more than 12 weeks. Chronic pain may arise from an initial injury, such as a back sprain or often there may be no clear causes. Chronic pain compromises people’s quality of life greatly and is one of the difficult conditions to treat. There is no test that can measure and locate pain with precision. Chronic pain may occur in a variety of locations in the body and for many different reasons, it is important to identify the causes and symptoms and locate the pain origin and get the pain treated.

Chronic pain can be mild or severe, episodic or continuous. Pain signals constantly stimulate nervous system for months or years. This can make great impact on a person’s physically and emotionally. The most common chronic pain is from headaches, joint pain, back pain, shoulder pain, pelvic pain, neck pain and pain from any injuries. The symptoms of chronic pain mainly are pain from mild to severe that does not go away. It can be shooting, burning, aching or electrical; or feeling discomfort, soreness, tightness or stiffness.

Chronic pain is closely related to emotions. Anxiety, stress, depression, anger and fatigue make the pain worse. These negative feelings may increase the level of substances that amplify sensations of pain, causing a vicious cycle of pain. The pain can suppress the immune system causing other symptoms.

Apart from the pain, there could be other symptoms including fatigue, sleeplessness, frequently having cold, changes in mood such as depression irritated anxiety and stress. Chronic pain may limit a person’s movements, which can reduce flexibility, strength, and energy.

Pain is a very personal and subjective experience. There is no test that can measure and locate pain with precision. Finding tender points can help locate the source of the pain.

Acupuncture is an effective treatment method for chronic pain. Acupuncture is a treatment derived from ancient Chinese medicine, it becomes popular worldwide. In the UK it is used in many NHS general practices, as well as the majority of pain clinics and hospices. The application of acupuncture in Western medicine is based on proper medical diagnosis and scientific evidence. The theory is that acupuncture can stimulate nerves under the skin and in muscle tissue. This results in the body producing pain-relieving substances, such as endorphins. It is likely these substances are responsible for any beneficial effects seen with acupuncture.

Acupuncture is recommended by the National Institute for Health and Care Excellence (NICE) as a treatment option for chronic lower back pain, chronic tension-type headaches and migraines. This recommendation by NICE is on the basis of scientific evidence. Acupuncture treatment for neck pain is also recognised as effective one.

Acupuncture is an effective treatment for chronic pain conditions

Acupuncture is well accepted to treat chronic pain conditions. 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.

What is important when using acupuncture to treat chronic pain

Many researches with huge sample sizes showed that acupuncture is effective to treat chronic pain. Acupuncture is not a standardized treatment method. If you see different acupuncturists, you would receive acupuncture with different characteristics for sure. There are different styles of acupuncture, Chinese acupuncture, Western acupuncture or mixed Chinese and Western acupuncture, which are based on different theories. Even for the same style of acupuncture, the duration and frequency of the treatments could be different performed by different acupuncturists. The points used are different by different acupuncturists which give you different effects.

From research point of view, there is a great variation of acupuncture characteristics. MacPherson et al analysed the research trials for acupuncture effect on chronic pain. Majority of research trials (59%) was based on traditional Chinese acupuncture and majority of points (55%) selected were flexible. Most of the research trials are manually stimulated and only a few trials used electrical stimulation and a few trials added with moxibustion. Attempts to obtain de qi sensation were made in all 25 trials which provided this information. The maxium number of sessions varied broadly from 3 to 30 and duration of sessions also varied from 15-32 minutes. The needles or points used were range from 1-18 points. The frequency of treatment was from one session every eight days to two sessions a week.

Their results showed that when comparing acupuncture with sham acupuncture controls, there was little evidence that the effects of acupuncture on pain were modified by any of the acupuncture characteristics evaluated, including style of acupuncture, number or placement of needles, the number, frequency or duration of sessions, patient-practitioner interactions and experience of the acupuncturist. When comparing acupuncture to non-acupuncture controls, better pain outcomes were obtained when more needles were used and also when a higher number of acupuncture treatment sessions were provided. They conclude that there was little evidence that different characteristics of acupuncture or acupuncturists modified the effect of treatment on pain outcomes. Increased number of needles and more sessions are associated with better outcomes when comparing acupuncture to non acupuncture controls. They suggested that dose is the key factor.

There was a report that investigated the outcomes of acupuncture for chronic pain in urban primary care from New York. Patients selected for the acupuncture treatment were over 21 years old with chronic pain caused by osteoarthritis or neck or back pain. Acupuncture was provided by supervised acupuncture students for up to 14 weeks. Pain and function were evaluated before during and after acupuncture treatment. They found that back pain was the most common referring diagnosis 59.5% followed by osteoarthritis 16.3%. Pain severity and function significantly improved at 12 and 24 weeks after baseline assessment. They concluded that weekly acupuncture improved pain severity and quality of life.

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 is used for women with chronic pelvic pain

If you've had pelvic pain for six months or more that either comes and goes or is continuous, it is known as chronic pelvic pain (CPP). CPP is more intense than ordinary period pain and lasts for longer. It affects around one in six women. A research paper studied the prevalence of and factors associated with use of complementary health approaches mong women with CPP. The result has shown that slightly over one-half (51%) of women with CPP used at least one complementary health approach in the past year, including acupuncture (8%), special foods or diets (22%), herbs (27%), and vitamins and minerals (29%). During follow-up surveys conducted annually for 4 years, a substantial proportion of women (44.8%) used complementary health approaches at more than half of the assessments. Users of complementary health approaches were more likely to undergo a hysterectomy or oophorectomy or to use gonadotropin-releasing hormone agonists or opioids during the study compared with nonusers. Women with CPP who used complementary health approaches also had more optimal health-related quality of life measured by the Pelvic Problem Impact Questionnaire.

Acupuncture for chronic knee pain

Chronic knee pain is a common condition. Acupuncture is shown as an effective treatment for chronic knee pain. A new research paper updated new research data and analysed the effectiveness and safety of acupuncture for chronic knee pain. Seventeen randomised controlled trials of acupuncture as the sole treatment or as an adjunctive treatment for CKP were assessed. The results showed that acupuncture alone or combined with other treatment was associated with significantly reduced chronic knee pain at 12 weeks. No risk of application of acupuncture was found in the studies. This study is consistent with previous research that acupuncture is effective for chronic knee pain and support the management for knee pain using acupuncture treatment.

Acupuncture is the best option for depression with pain problems

Up to about 70% patients with depression also have pain problems. Depression may make the pain problem worse and more pain may make depression worse as well. The existing research data has shown that acupuncture is an effective treatment option for several chronic pain conditions. Acupuncture is also suggested to treat depression, though this is not available option in NHS. Counselling for depression is widely available in primary care practices, however there is limited evidence for counselling compared to usual care as a treatment for patients with depression and a chronic physical health problem. Recently a report compared acupuncture or counselling with usual care alone for 755 patients with depression complicated with pain. They found that at 3 months, both acupuncture and counselling interventions were effective for depression compared to usual care alone whether there was pain or not. Patients in the pain group had greater reductions in both depression symptoms with acupuncture from baseline to 3 months than those who received counselling or usual care. All treatment options were effective in reducing pain between baseline and 3-month follow-up after controlling for baseline pain, however, acupuncture delivered a greater degree of pain relief than counselling or usual care in the short-to-medium term. Reductions in both depression and pain were most marked in the acupuncture group, followed by the counselling group and then the usual care group.

Complex regional pain syndrome (CRPS) is a condition in which a person experiences persistent severe and debilitating pain. This condition is poorly understood. The pain is usually confined to one limb, but it can sometimes spread to other parts of the body. The main symptom of CRPS is pain, which can sometimes be severe, continuous and debilitating. The pain may be a mix of burning, stabbing or stinging sensations, but there may also be a tingling sensation and numbness. The skin of the affected body part can become so sensitive that just a slight touch, bump or even a change in temperature can provoke intense pain. Other symptoms accompanied with the pain include muscle tremor and spasm, affected joints stiffness, sleep problem and changes of the skin etc. Acupuncture is an effective way for pain relief. Why not try to see if it works for you.

People benefit most from acupuncture treatment

The effects of acupuncture vary depending on the conditions, skills of acupuncturists, individuals sensitivities to the treatment. A research from Gemany studied the patient characterisitics and variation in acupuncture treatment outcome to find out which pateitns benefit most from acupuncture for chronic pain. Patients with chronic low back pain, headache, neck pain, or pain due to osteoarthritis of the knee or hip, were included. All patients received routine care; the patients randomized to the acupuncture group received additional acupuncture treatment. In this study total of 9,990 patients were treated by 2,781 physicians. The results have shown significant improvement in the acupuncture group. Patients benefit most from acupuncture for chronic pain are that enlarged the acupuncture effects were being female, living in a multi-person household, failure of other therapies before the study, and former positive acupuncture experience.

Acupuncture for chronic pain, acupuncture points used is important

The effect of acupuncture treatment for chronic pain is controversial in research paper, though acupuncture is widely used in clinical practice and accepted by many doctors and patients. The concern is if acupuncture is effective for chronic pain or the effect lasts. Recently a study analysed individual patient data to examine the effect of acupuncture for chronic pain condition including non-specific musculoskeletal pain, osteoarthritis, chronic headache, or shoulder pain. 20,827 patient data were included. The pain and function were measured in this study. The result has shown that there was a clear effect of acupuncture compared to control and the effects of acupuncture persist over time with only a small decrease, approximately 15%, in treatment effect at one year. They conclude that acupuncture is effective for the treatment of chronic pain, with treatment effects persisting over time; the specific effects of needling at correct acupuncture point locations are important contributors to the treatment effect and a course of treatment is necessary for the treatment.


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