Treatment of Pain, Part 3: ACUPUNCTURE

Pain is a global problem. Over 1.5 billion people worldwide suffer from chronic pain. Nearly 1/3 of American adults experience chronic pain, and almost one in five surveyed Europeans said they have moderate or severe chronic pain. The 3 most common sources of pain are low back pain (29%), neck pain (16%), and severe headache or migraine pain (15%).

Pain effects quality of life. Nearly 2/3 of people with chronic pain have problems sleeping. Lack of restorative sleep often makes the pain worse, resulting in a frustrating cycle of pain and sleeplessness. Unrelieved pain can result in longer hospital stays, increased re-hospitalizations, increased outpatient visits, and decreased ability to function, leading to lost income and insurance coverage. In addition to the financial burden that comes with chronic pain, the emotional costs to patients and families can be high as well.

Chronic pain constitutes a tremendous expense to employers in healthcare and rehabilitation costs, and lost worker productivity. Migraine is the third most prevalent illness on the planet and a 2015 study showed that headache pain was the most commonly attributed cause of lost work productivity in the US.

Drugs are often prescribed for pain as a first line of treatment, but as has been noted here previously, they can cause their own set of problems. Only 23% of chronic pain sufferers found prescription opioids effective, according to a 2016 survey conducted by the American Pain Foundation. The first randomized study to ever evaluate the long-term effectiveness of opioids for pain relief found that those taking opioids were actually in more pain at 12-months compared to those who were on non-opioid pain relief!

Non-steroidal anti-inflammatory drugs (NSAIDS), the most commonly used medications in the world, are another commonly prescribed first-line treatment for pain. However, NSAID use poses a significant risk of acute heart attack, even in healthy people. That’s in addition to the well-known risks of GI bleeding and kidney problems. Acetaminophen (tylenol), which is another commonly used pain medicine, also carries an increased risk of heart attack, GI bleeding, and kidney damage, and high quality evidence suggests it is not a good long-term pain solution.

Acupuncture is excellent for pain. It has virtually no side effects, and is cost-effective. Its unique in reducing pain is one of the main reasons it is so popular around the world. We have known since 1974 that acupuncture stimulates the release of endogenous opiates like endorphins, dynorphins, and encephalins, morphine-like substances that our bodies naturally produce.

For acute pain a systemic review of 13 trials found acupuncture more effective than both sham needling and injection with painkillers. For chronic pain, in the largest study of its kind to date, 454,920 patients were treated with acupuncture for headache, low back pain, and/or osteoarthritis in an open trial. Effectiveness was rated as marked or moderate in 76% of cases by the 8,727 treating acupuncturists. In a 2-year retroactive survey of over 89,000 patients published in 2016, 93% of patients said that their acupuncturist had been successful in treating their musculoskeletal pain.

A meta-analysis of 17,922 patients from randomized trials concluded that acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo, especially as a follow up study within this data looking at the long- term pain relief found that the benefits of acupuncture persisted for 12 months after treatment ended.

While there is still much to learn about acupuncture mechanisms and the human body in general, the neural pathways from acupuncture point stimulation, to the spinal cord to the deactivation of the pain centers in the brain have been mapped. As said previously, acupuncture activates a number of the body’s opioids as well as improving the brain’s sensitivity to opioids. And a number of other biochemicals involved in pain reduction have been found to be released or regulated by acupuncture stimulation, including ATP, adenosine, GABA, and substance P.

In the context of ineffective and sometimes dangerous pharmaceutical options for pain, acupuncture represents a safe and effective alternative with a long track record of successful use.