Chronic pain, which affects 100 million adults in the United States, continues to be an immense clinical problem. In one pain survey, more than half of the respondents (51 percent) felt they had little or no control over pain. About 77 percent of respondents reported feeling depressed, and 74 percent said their energy levels were impacted by their pain.
Options for treating pain include topical therapies, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, antidepressants, anticonvulsants, muscle relaxants and opioids. Alternative modalities, such as acupuncture and transcutaneous electro-nerve stimulator units, may help to reduce some types of pain symptoms, and interventional techniques may involve relatively superficial injections into the painful muscles or may involve more invasive procedures.
In the past decade, interest in and use of acupuncture for pain in the U.S. has grown. In Eastern tradition, pain is thought to result from blockage or stagnation of the normal movement of energy (qi) in the area that hurts. Acupuncture is thought to restore the normal flow of qi.
In modern scientific studies, acupuncture has been shown to have several effects on the central and peripheral nervous systems, and these effects along with other physiologic mechanisms are presumed to change pain perception, although the exact mechanism is still unknown.
Research from an international team of experts adds to the evidence that acupuncture does provide real relief from common forms of pain. The team pooled the results of 29 studies involving nearly 18,000 participants. Some had acupuncture, some had "sham" acupuncture, and some didn't have acupuncture at all. Overall, acupuncture relieved pain by about 50 percent.
However, the debate and controversy about whether physicians should recommend acupuncture for pain continues. Some physicians feel strongly that acupuncture shouldn't be recommended for pain because there is no convincing evidence of clinical benefit and that the potential risks and health service costs are unjustified.
Others support that view, insisting that most physicians would be skeptical of any drug trial comparing the drug with usual treatment without implementing blinding by using placebo, even going so far as to state that acupuncture cannot be ethically recommended for any medical condition.
Despite decades of research and hundreds of acupuncture pain trials, including thousands of patients, such skeptics point out that there is no clear mechanism of action, as well as insufficient evidence for clinically worthwhile benefit and possible harms. Yet there is the argument that patients have the right to be informed based on clinical trials even if the effect of acupuncture is small, uncertain and below usual thresholds for clinical relevance.
In a recent article, Mike Cummings, Medical Director of the British Medical Acupuncture Society, defends his position that acupuncture is a safe alternative to drugs but in Western medicine is being tyrannized by an inappropriate focus on efficacy studies. He thinks that physicians need to consider pragmatic comparisons to determine how useful acupuncture can be, including exploring sham-controlled data to examine mechanisms and biologic possibilities without making judgments on clinical usefulness by comparing acupuncture with other needling techniques.
The biggest and most robust dataset for acupuncture in chronic pain is noted in a review of data from 20,827 patients that showed moderate benefit for acupuncture compared with usual care but smaller effects compared with sham acupuncture. The study also showed that 85 percent of the effect of acupuncture was maintained at one year.
For some patients, especially those with chronic musculoskeletal pain and other arthritis, and for elderly patients who are particularly at high risk for adverse effects of adverse drug reactions, acupuncture is an option with a favorable risk-to-benefit ration, which is why some guidelines recommend acupuncture for treating pain.
Still, some physicians do not believe acupuncture can be ethically recommended for any medical conditions. Whether the two sides on this debate ever reach a consensus remains doubtful.
