Acupuncture helps Acute Pain

Acupuncture in Exeter: acupuncture helps acute pain. Acupuncture helps acute pain is the assessment of collaborators from four American medical and nursing schools. They concluded that the majority of reviews found acupuncture to be efficacious for acute pain, with potential to avoid or reduce opioid reliance. The research updates the evidence base for acupuncture for acute pain, with a review of systematic reviews and meta-analyses on postsurgical/perioperative pain with opioid sparing, and acute nonsurgical/trauma pain. The latter included pain in the emergency department.

In the US, there has been mounting pressure for pain medicine to shift away from an overreliance on opioids and overutilized procedures and surgeries, toward more comprehensive pain care that includes evidence-based non-pharmacological strategies. The researchers say that the evidence base for acupuncture is extensive. Acupuncture is supported or recommended as part of pain care by the US Agency for Healthcare Research and Quality, the US Food & Drug Administration, the US Department of Health and Human Services, and the largest hospital accreditation organization in the US, The Joint Commission. Further, the American Academy of Family Physicians endorsed the American College of Physicians Guidelines recommending acupuncture as a first option for acute, subacute, and chronic lower back pain.

A total of 22 systematic reviews, including 17 with meta-analyses of acupuncture in acute pain settings and a review for pain in the intensive care unit, were included in this study. In the emergency department setting, studies reported high acceptability of acupuncture by patients. Acupuncture produced a decrease in pain comparable to that produced by drugs, with the additional benefit of a reduction in anxiety.

The effectiveness of acupuncture coupled with a very low rate of adverse events, is reflected in the authors’ summary. “The evidence supporting effectiveness, safety, reduced need for opioids and NSAIDs, and improved patient satisfaction is a compelling reason for acupuncture therapy to be covered for acute pain by public and private insurance. Policy barriers preventing licensed acupuncturists from being Medicare-billing providers need to be addressed. Health care practitioners and administrators need training in the evidence base for acupuncture therapy, and they need to advocate for policy initiatives that remedy systemic reimbursement barriers to evidence-based comprehensive pain care strategies.”

(Acupuncture Therapy as an Evidence-Based Nonpharmacologic Strategy for Comprehensive Acute Pain Care: The Academic Consortium Pain Task Force White Paper Update. Pain Medicine, September 2022.)

Ear Acupuncture Reduces Pain After Surgery

Acupuncture in Exeter: ear acupuncture reduces pain after surgery American clinicians have found that a type of ear acupuncture termed battlefield acupuncture, reduces pain and opioid use in military veterans undergoing surgery. A total of 72 patients, mean age 64 and scheduled for major surgery under general anaesthesia, were randomly assigned to receive either ear acupuncture or sham acupuncture for postoperative pain. Surgery was typically abdominal, thoracic or for hip/knee replacements.

Median postoperative opioid consumption was significantly lower in the acupuncture group (18 units) compared to the sham group (39 units). Also lower in the acupuncture group, were subjective pain intensity, nausea and vomiting. Only one acupuncture group patient experienced nausea, compared with 13 in the sham group.

The researchers conclude that  the diminished postoperative pain intensity, reduced postoperative opioid requirement, and the lower incidence of postoperative nausea and vomiting observed, demonstrate the potential advantages of this low-cost and low-risk therapy in this patient population. Further research is needed to test its effectiveness in individual surgical procedures.

(Battlefield Acupuncture Use for Perioperative Anesthesia in Veterans Affairs Surgical Patients: A Single-Center Randomized Controlled Trial. Journal of Integrative & Complementary Medicine, 10 August 2022.)

NICE Recommends Acupuncture for Chronic Pain

The latest NICE guideline on treatment of chronic pain, recommends acupuncture, exercise or psychological therapies, as non-pharmacological approaches to managing chronic primary pain. By contrast, paracetamol, non-steroidal anti-inflammatories and opioids, are not recommended.

The NICE committee which devised the guideline acknowledged that there is now a large evidence base for acupuncture’s short term effectiveness. They cited 27 studies showing it reduced pain and improved quality of life for up to three months.

(Chronic pain (primary & secondary) in over 16s: assessment of all chronic pain & management of chronic primary pain. NICE guideline [NG193], 7 April 2021.)

Acupuncture Before Surgery helps Veterans

Research from America: Acupuncture before surgery helps veterans. US military veterans who have acupuncture before surgery, report less pain and need far fewer opioids to manage their discomfort. In the randomized, controlled study presented at the 2020 annual meeting of the American Society of Anesthesiologists, the veterans were also more satisfied with their pain control.

“Six percent of patients given opioids after surgery become dependent on them, and veterans are twice as likely to die from accidental overdoses than civilians,” said Brinda Krish, D.O., lead author of the study and an anesthesiology resident at Detroit Medical Center. “Clearly it is crucial to have multiple options for treating pain, and acupuncture is an excellent alternative. It is safe, cost effective and it works.”

Researchers treated two groups of patients at the John D. Dingell VA Medical Center in Detroit. One group due for hip replacement were randomly assigned to either acupuncture or a control group before surgery. The other included patients undergoing a variety of procedures (including gallbladder removal, hernia repair, hysterectomy or prostate surgery); these were also randomly assigned to either acupuncture or a control group before surgery.

In the first group, patients who had not received acupuncture consumed nearly three times as much morphine in the first 24 hours after surgery, as those who had the treatment. Acupuncture patients reported less pain and 14% reported less anxiety.

In the second group, acupuncture patients consumed only half as many opioids as those in the control group. Only 3% reported nausea and vomiting after surgery, compared to 38% of the control group.

(American Society of Anesthesiologists 2020 Annual Meeting News.)

Acupuncture for Chronic Pain

A large systematic review by researchers in the US, China and the University of Oxford, shows acupuncture should be given for at least five weeks in order to achieve 80% of maximum analgesic effect. A total of 77 randomised trials of acupuncture for chronic pain of the shoulder, neck, knee and lower back were included. They covered 8830 patients. Higher initial pain intensities were found to result in higher acupuncture pain relief.

(The response-time relationship and covariate effects of acupuncture for chronic pain: A systematic review and model-based longitudinal meta-analysis.European Journal of Pain, 13 June 2020.)