Category: Pain

In 2017, the US National Association of Attorneys General wrote to health insurers, asking them to review their policies and promote treatments such as acupuncture, physical therapy and massage, as alternatives to opioid painkillers. Opioid overdose is killing 91 Americans every day, and more than half of these deaths involve prescription drugs. Shortly afterwards, American acupuncture organisations published their joint paper showing how acupuncture could contribute to solving this crisis.

Numerous US federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacologic treatment options for pain. Acupuncture stands out as the most evidence-based, immediately available choice to fulfil these calls. The authors recommend it as a powerful option which can be used as a first-line, drug-free method for pain relief and management. It can safely and cost-effectively be incorporated into diverse medical settings, resulting in significantly decreased healthcare expenditure, by both treating pain and avoiding opioid addiction. The US Military & Veterans Administration has already used acupuncture to successfully decrease the volume of opioids prescribed.

(Acupuncture’s Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management – White Paper 2017. Journal of Integrated Medicine, November 2017.)

Authors of an American systematic review have found acupuncture to be effective for acute pain in the hospital emergency department setting. Meta-analyses were performed on data from 14 randomised controlled trials covering a total of 1210 patients. The trials compared acupuncture with sham, acupuncture with standard analgesia, and also examined acupuncture as an adjunct to standard care.

Acupuncture was more clinically effective than sham, and comparable with conventional drug therapy for acute pain. It was also associated with improved patient satisfaction, lower costs and fewer adverse effects. There was limited evidence suggesting superior results may be achieved when adding adjunctive acupuncture to standard analgesia.

(Does acupuncture have a role in providing analgesia in the emergency setting? A systematic review and meta-analysis. Emergency Medicine Australasia, 26 July 2017 epub ahead of print.)

The largest ever pragmatic, randomised trial looking at acupuncture undertaken in hospital emergency departments, has found it is a safe and effective alternative to conventional drugs for acute pain. A total of 1964 patients presenting at four Melbourne hospitals with back pain, migraine and ankle sprain, were randomised to receive acupuncture, acupuncture plus analgesics, or analgesics alone. All patients had to complain of pain rated a minimum of 4 on a 10-point verbal scale. Although neither drugs nor acupuncture offered clinically relevant pain reduction within an hour, patients found either treatment acceptable. The effectiveness of acupuncture was comparable with that of drugs.

(Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial. Medical Journal of Australia, 2017.)

American researchers have reported that acupuncture is a feasible treatment to relieve pain in the hospital intensive care unit (ICU). Forty-six patients in ICU who were experiencing pain and/or nausea, received three 20 minute acupuncture treatments in addition to usual care.

Self-reported pain levels decreased by a mean 2.4 points on a 10-point scale, a reduction which exceeds the commonly accepted threshold for clinically relevant analgesia. A significant decrease in morphine usage was observed after each treatment. Additionally, 49% of patients spontaneously reported a reduction in anxiety. No major adverse effects were reported.

(Acupuncture for Pain and Nausea in the Intensive Care Unit: A Feasibility Study in a Public Safety Net Hospital. Journal of Alternative & Complementary Medicine, April 2017.)

Researchers in York funded by the National Institute for Health Research, have assimilated evidence from high-quality trials of acupuncture for chronic pain, including neck and lower back pain, osteoarthritis of the knee, and headache and migraine. Altogether, nearly 18,000 patients were included.

They concluded that acupuncture was more effective than both usual care and sham acupuncture, and that acupuncture is one of the more clinically effective physical therapies for osteoarthritis.

(Acupuncture for chronic pain and depression in primary care: a programme of research. NIHR Journals Library, January 2017.)

A meta-analysis of 20 high-quality randomised trials of acupuncture for chronic pain, shows the beneficial effects of acupuncture persist for at least 12 months. The studies covered data on 6376 patients for conditions such as lower back, neck, and shoulder pain, plus osteoarthritis of the knee, and headache/migraine. The researchers found that in studies comparing acupuncture with a non-acupuncture control such as usual care etc, about 90% of the benefit of acupuncture relative to controls, was sustained 12 months after treatment. In trials comparing acupuncture with sham, the corresponding figure was 50%.

The authors conclude that patients can be reassured that acupuncture offers long-term relief for chronic pain, and that this should be taken into account when assessing the cost-effectiveness of acupuncture.

(The persistence of the effects of acupuncture after a course of treatment: A meta-analysis of patients with chronic pain. Pain, online 17 October 2016.)