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The practice of acupuncture therapy began more than 2000
years in the past. Doctors of ancient China were somehow able to identify 14
meridians on the body along which lie the acupuncture points. The practice has
survived longer than most medical procedures still practiced today. Traditional
beliefs claim that flowing through the body are two opposite but complementary
energies, Yin and Yang. Yin is associated with femininity, cold, dark, quiet,
night, and winter. Yang is associated with masculinity, heat, light, vitality,
day, and summer. According to this Yin/Yang theory, the balance of Yin and Yang
must be maintained in order for a person to be healthy. Chinese acupuncturists
consider their art a way of restoring balance in a person internal energies.
Throughout its long history acupuncture has been thought and observed to relieve
pain but conclusive scientific experiments had yet to be conducted. Western
medicine can not reconcile internal energy balancing with the experimental
scientific information available. Whether the traditional explanation of the
effects of acupuncture is true or not, the studies indicate very strongly that
acupuncture is an effective method to decrease pain in many of its forms and
speeds recovery from pain due to injury and surgical procedures.
I conducted a Medline search using the keyword acupuncture and pain to gain access to the articles referenced in the following section. It took a lot of searching through studies that did not produce very conclusive results to find the ones that did.
Although there are numerous studies on acupuncture and pain, many of them have questionable elements and therefore may not produce reliable results. They constitute the preliminary studies one might conduct before conducting a controlled, randomized clinical trial. For example, the results of a study by Rapson et al at the Toronto Rehabilitation Institute suggested that acupuncture was promising treatment for below-level central neuropathic pain. These were results were obtained from a retrospective chart review of 36 individuals with traumatic and non-traumatic spinal cord injury who met a set of inclusion criteria (inclusion criteria were not mentioned in the abstract). 24 out of the 36 showed improvement after treatment with an electroacupuncture protocol. It was found that of the 24 who showed improvement, the ones whose burning pain was characterized as bilateral, symmetric, and constant were the most likely to improve from the acupuncture treatment. The conclusion of this study suggested that the acupuncture protocol used may be an effective treatment for SCI victims experiencing below-level central neuropathic pain, but also states that additional prospective clinical studies are needed to confirm these findings. A randomized, controlled, blinded clinical study would be more desirable.
Another study at a German clinic performed by Konig et al compared conventional massage and sham laser acupuncture to real acupuncture in their ability to improve the range of motion of the neck of patients with chronic neck pain. In this prospective, randomized, placebo-controlled study, 177 patients with chronic neck pain were randomly assigned to acupuncture, massage, and sham acupuncture groups and given 5 treatments over 3 weeks. The conclusion of the study stated that acupuncture was shown to be a (statistically) significantly better treatment to conventional massage, but the effects of true acupuncture were not shown to be significantly greater than the effects of sham acupuncture. An attempt was made to create more control in this study, but results show improvement in range of motion with both real and sham acupuncture when compared to conventional massage The study raises questions about whether a person's expectation affects the outcome more than the treatment. This study was also probably not done over a long enough time span to produce conclusive results.
The previous two studies suggest the possibility that acupuncture is an effective treatment for pain. These preliminary results have led to more studies on acupuncture therapy. In 1997 there was a panel on acupuncture at the Institute of Health Consensus Conference at which it was determined that scientific evidence demonstrated the effectiveness of acupuncture in treatment of multiple types of pain. The conference was attended by experts from various fields related to the treatment of pain. These experts discussed evidence gathered from databases on many studies on acupuncture therapy. The complete statement can be viewed at: http://consensus.nih.gov/cons/107/107_intro.htm.
The panel recognized the problems with studies such as those described earlier, but also stated that promising results had been observed and that further research was likely to reveal new applications of acupuncture therapy. As will be seen from the following studies, the results have indeed been promising.
Within the past two years, studies have been completed that provide stronger evidence of acupuncture’s effectiveness in treatment of pain. In a 2002 study conducted by Gilbertson et al acupuncture was shown to be an effective method in reduction of pain in patients recovering from arthroscopic acromioplasty. 40 patients were randomized into acupuncture and sham acupuncture groups, and recovery/pain was measured using several different methods. All of the patients believed they were receiving real acupuncture, although it is stated in the study that having a low number of subjects tends to increase the effect of bias. Improvement was evident based on data from the UCLA shoulder scale, pain intensity measures, self reported analgesic use, angles of abduction, and 6 of 8 health status questionnaires, and there was a four month follow up on the status of each patient. The study concluded that real acupuncture was significantly more effective in treatment of post-operative pain and improved recovery compared to sham acupuncture.
In another 2002 study by C.F. Meng et al the effectiveness of acupuncture was tested on chronic lower back pain in older patients (age > 60 yrs). 47 patients were randomized to two groups, one group following the regular advice of their physician to treat lower back pain (NSAIDS, muscle relaxants, paracetamol and back exercises), the other additionally receiving acupuncture with electrical stimulation twice a week for 5 weeks. The results were measured using the Roland Disability Questionnaire. The scores of the subjects indicated that the patients receiving acupuncture showed significantly greater improvement in condition than the control group. The study supported acupuncture as a safe and effective treatment for chronic lower back pain in elderly patients.
One final study of note is a 2002 study by Richard Chen and J. Curtis Nickel. In this study 12 men diagnosed with chronic prostatitis/chronic pelvic pain syndrome and were refractory (resistant) to standard therapies such as antibiotics, alpha-blockers, anti-inflammatory, and phototherapy. These men underwent a minimum of six weeks of acupuncture treatment and there was an average follow up 33 weeks from baseline. The men completed the NIH Chronic Prostatitis Symptom Index at baseline, 6 weeks, 12 weeks, and at least 6 months from the baseline assessment. The treatment worked in all the subjects at least to some extent. Although there is no control group in this study and the group of subjects is very small, I think it is worthy of mention because the patients in this case were not responding to other more standard therapies. Acupuncture seemed to have something that the other treatments did not have. It is important as scientists to let the results of such studies help guide research in directions that show promise.
Acupuncture has been accepted by many in the medical and scientific community as an effective treatment for pain. However, there was not much discussion on exactly why acupuncture works. A 2000 study by Biella et al showed using PET scans that acupuncture caused activation of pain regions in the brain. Research continuing along this path will help us to the physiological change that is induced by acupuncture therapy. Furthermore, we may be able to reconcile it with what we know about medicine and explain the scientific story behind the Yin-Yang balance within the body. It is interesting that a medical procedure which was mapped out over 2000 years ago should be in the realm of current research and is producing promising results in the treatment of pain. Clearly we are fortunate to have the technology to learn about acupuncture available. While more research must still be conducted, there is a strong body of evidence that suggests acupuncture as an effective treatment for numerous types of pain.
Chen, R., Nickel, J.C. (2003). Acupuncture ameliorates symptoms in men with chronic prostatitis/chronic pelvic pain syndrome. Urology. Volume 61, Issue 6, June 2003.
Gilbertson, B., Wenner, K., Russell, L.C. (2003). Acupuncture and arthroscopic acromioplasty. Journal of Orthopaedic Research. Volume 21.
Konig, A., Radke, S., Molzen, H., Haase, M., Muller, C., Drexler, D., Natalis, M., Krauss, M., Behrens, N., Irnich, D. 2003. [Randomised trial of acupuncture compared with conventional massage and ham laser acupuncture for treatment of chronic neck pain range of motion analysis]. Z Orthop Ihre Grenzgeb. 2003 Jul-Aug.
Meng, C.F., Wang, D., Ngeow, J., Lao, L., Peterson, M., Paget, S.(2003). Acupuncture for chronic low back pain in older patients: a randomized, controlled trial. Rheumatology. Volume 42.
National Institute of Health Consensus Development Panel on Acupuncture (large panel of contributors). Journal of the American Medical Association. Vol. 280, No. 17, Nov. 4, 1998.
Rapson, L.M., Wells, N., Pepper, J., Majid, N., Boon, H. (2003). Acupuncture as a promising treatment for below-level central neuropathic pain: a retrospective study. Journal of Spinal Cord Medicine.
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