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 could be different as well. Additional usage of electrostimulation or electroacupuncture, moxibustion or manipulation could be applied by some acupuncturists.

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.