Category: Pain

Clinicians have published a report of a patient with phantom limb pain, successfully treated with acupuncture within a Swansea GP practice. The 45-year-old man was suffering pain and sensation following amputation of his forearm above the elbow twelve weeks earlier. After seven weekly acupuncture sessions on his opposite arm, he experienced complete relief of the phantom limb pain and significant improvement of the phantom sensations. He remained free of pain at follow-up after 5 months.

The author, a GP within the practice, concludes that the patient derived considerable benefit from short sessions of acupuncture. This benefit was commented on when he attended a secondary care pain control clinic which was unaware that he was having acupuncture in primary care. The clinic letter noted a dramatic improvement in his symptoms.

(Acupuncture Treatment of Phantom Limb Pain and Phantom Limb Sensation in a Primary Care Setting. Acupuncture in Medicine, on-line 6 December 2012.)

An international collaboration which included some of the UK’s leading acupuncture researchers, has provided definitive evidence that acupuncture is effective for chronic pain. The collaboration gathered individual patient data for nearly 18 000 patients who took part in 29 high-quality, randomised, controlled trials of acupuncture for four chronic pain conditions: back and neck pain, shoulder pain, headache and osteoarthritis.

For each of the four conditions, true acupuncture was superior to control, and significantly more effective than usual care alone. The researchers conclude that this study provides the most robust evidence to date that acupuncture is a reasonable referral option for patients with chronic pain. The significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture. They hope that their findings will inform policy-making aswell as encourage clinicians to recommend acupuncture as a safe and effective treatment.

(Acupuncture for Chronic Pain: Individual Patient Data Meta-Analysis. Archives of Internal Medicine, 10 September 2012.)

Most research compiled here, concerns the clinical efficacy of acupuncture, so here I have included an economic assessment for a change. UK researchers have undertaken a systematic review of the cost-effectiveness of acupuncture for chronic pain. They looked among other things at eight economic evaluations and one cost-effectiveness analysis, covering the treatment of lower back pain, neck pain, period pain, migraines, arthritis and headaches.

Correlations were uncovered between the clinical benefits of acupuncture and medical cost savings. The UK National Institute for Health and Clinical Excellence, is normally willing to pay for treatments shown to cost up to £20 000 to £30 000 per quality life adjusted year gained; the figures for acupuncture were shown to range from only £2 500 to £15 000. Given policy-makers’ needs to base treatment access on economic as well as clinical factors, the researchers were able to conclude that acupuncture appears to be a cost-effective intervention for some chronic pain conditions.

(Costs and Consequences of Acupuncture as a Treatment for Chronic Pain: A Systematic Review of Economic Evaluations Conducted Alongside Randomised Controlled Trials. Complementary Therapies in Medicine, October 2012.)

A randomised controlled trial conducted in Italy, has found that acupuncture is as good as standard drug treatment for helping the pain of acute herpes zoster (shingles).

A total of 102 patients were randomised to receive either acupuncture or standard drug treatment (comprising as many as several drugs, as required), for four weeks. The acupuncture was administered twice per week. Both treatments were judged to be effective with no significant differences between the two groups as measured by response rates and pain scores. The authors conclude that given the reduced likelihood of cumulative drug toxicity in patients receiving acupuncture, this option is promising for future treatment of acute shingles pain.

(Acupuncture for the Treatment of Severe Acute Pain in Herpes Zoster: Results of a Nested, Open-label, Randomised Trial in the VZV Pain Study. BMC Complementary & Altern Medicine, June 2011.)

American researchers have evaluated the usefulness of acupuncture for postoperative pain. They conducted a systematic review of the evidence, including fifteen randomised controlled trials of acupuncture versus a sham control, and found that at 8 hours and 72 hours after surgery, the acupuncture groups were using significantly less opioid painkillers (eg. codeine and morphine). Furthermore, acupuncture treatment was associated with fewer opioid-related side-effects, such as nausea, sedation, dizziness, itching and urinary retention.

The authors conclude that their review suggests the perioperative administration of acupuncture may be a useful adjunct for postoperative analgesia. Further large, well-designed studies are required to confirm those findings and to answer questions regarding the most efficacious type of acupuncture and optimal timing of administration.

(Acupuncture and Related Techniques for Postoperative Pain: A Systematic Review of Randomised Controlled Trials. British Journal of Anaesthesia, August 2008.)