Tuesday, November 25, 2008

Any Thoughts on Accupunture and Pain?

Question: Is there any new data to support the use of acupuncture for pain?

Answer: Yes, there are some new data on the use of pain and acupuncture.

Note, for a review on my thoughts on pain, see the following posts

Myth Busters: Painful Soft Tissue Work
Pain Perception and the Neuromatrix of Pain
Pre-emptive Analgesics
Overload and Muscle Soreness (DOMS)

Recently there are 2 newer reviews on acupuncture and its effect upon pain.

The first one (below) is a review of 31 studies using acupuncture and sham acupuncture. Sham acupuncture is where they still poke you with a needle, but they are not putting it in the correct location. This is very important when reading studies (especially on acupuncture) since the placebo effect can be huge! Take one group and poke them with needles (acupuncture group) and don't do anything to the control group and many times you will see that the acupuncture group was better! Well, most in the treatment (acupuncture) group quickly figured out that they were in the treatment group and those that had nothing done quickly realized they were in the control group.

Many times it possible to have a control group. If you are doing a study on a new implantable medical device, it is considered unethical to implant the device in a group of patients that have NO medical need for it just to lessen the placebo effect. This can also make enrollment in some trials more difficult if the patients already believe the device will help them and may drop out if they are randomized to the control arm (no device).

So in our first acupuncture study they used only studies that had a comparison to the sham acupuncture group. They concluded "Needling acupuncture is superior to sham acupuncture and medication therapy in improving headache intensity, frequency, and response rate."

In the second study, they looked at post operative pain. While it does appear that they only took studies using acupuncture and a sham control procedure, it appears that there may be some benefit to acupuncture post surgery. Now this may be a placebo (not sure what they used for a sham control), but if by inserting a small needle into you allows your body to need fewer drugs for the same effect on pain--sign me up!

How does this relate to training?
1) Be sure to read studies closely and think about the placebo effect.
2) The mind is very powerful. You will achieve what you believe


Acupuncture for the Management of Chronic Headache: A Systematic Review. Sun Y, Gan TJ. Duke University Medical Center, Department of Anesthesiology, Box 3094, Durham, NC 27710.

Anesth Analg. 2008 Dec;107(6):2038-2047.

OBJECTIVE: The objective of this review was to evaluate the efficacy of acupuncture for treatment of chronic headache.

METHODS: We searched the databases of Medline (1966-2007), CINAHL, The Cochrane Central Register of Controlled Trials (2006), and Scopus for randomized controlled trials investigating the use of acupuncture for chronic headache. Studies were included in which adults with chronic headache, including migraine, tension-type headache or both, were randomized to receive needling acupuncture treatment or control consisting of sham acupuncture, medication therapy, and other nonpharmacological treatments. We extracted the data on headache intensity, headache frequency, and response rate assessed at early and late follow-up periods.

RESULTS: Thirty-one studies were included in this review. The majority of included trials comparing true acupuncture and sham acupuncture showed a trend in favor of acupuncture. The combined response rate in the acupuncture group was significantly higher compared with sham acupuncture either at the early follow-up period (risk ratio [RR]: 1.19, 95% confidence interval [CI]: 1.08, 1.30) or late follow-up period (RR: 1.22, 95% CI: 1.04, 1.43). Combined data also showed acupuncture was superior to medication therapy for headache intensity (weighted mean difference: -8.54 mm, 95% CI: -15.52, -1.57), headache frequency (standard mean difference: -0.70, 95% CI: -1.38, -0.02), physical function (weighted mean difference: 4.16, 95% CI: 1.33, 6.98), and response rate (RR: 1.49, 95% CI: 1.02, 2.17).

CONCLUSION: Needling acupuncture is superior to sham acupuncture and medication therapy in improving headache intensity, frequency, and response rate.

Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials.
Sun Y, Gan TJ, Dubose JW, Habib AS.

Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC 27710, USA.

Br J Anaesth. 2008 Aug;101(2):151-60. Epub 2008 Jun 2.

Postoperative pain management remains a significant challenge for all healthcare providers. The objective of this systematic review was to quantitatively evaluate the efficacy of acupuncture and related techniques as adjunct analgesics for acute postoperative pain management. We searched the databases of Medline (1966-2007), CINAHL, The Cochrane Central Register of Controlled Trials (2006), and Scopus for randomized controlled trials (RCTs) using acupuncture for postoperative pain management. We extracted data about postoperative opioid consumption, postoperative pain intensity, and opioid-related side-effects. Combined data were analysed using a random effects model.

Fifteen RCTs comparing acupuncture with sham control in the management of acute postoperative pain were included. Weighted mean difference for cumulative opioid analgesic consumption was -3.14 mg (95% confidence interval, CI: -5.15, -1.14), -8.33 mg (95% CI: -11.06, -5.61), and -9.14 mg (95% CI: -16.07, -2.22) at 8, 24, and 72 h, respectively. Postoperative pain intensity (visual analogue scale, 0-100 mm) was also significantly decreased in the acupuncture group at 8 and 72 h compared with the control group.

The acupuncture treatment group was associated with a lower incidence of opioid-related side-effects such as nausea (relative risk, RR: 0.67; 95% CI: 0.53, 0.86), dizziness (RR: 0.65; 95% CI: 0.52, 0.81), sedation (RR: 0.78; 95% CI: 0.61, 0.99), pruritus (RR: 0.75; 95% CI: 0.59, 0.96), and urinary retention (RR: 0.29; 95% CI: 0.12, 0.74).

Perioperative acupuncture may be a useful adjunct for acute postoperative pain management.