Posts Tagged ‘pain reduction’
Sep 12, 2012
Acupuncture is famous for the treatment of chronic pain. Chronic pain is one of the most common health concerns I see in my NYC acupuncture clinic. Back pain, headaches, migraines, shoulder pain, knee pain, neuropathy, arthritis, and other chronic pain conditions. Patients can have profound results.
In the clinic we know acupuncture is effective for pain, but often skeptics are vocal opponents because they believe that there is not enough research.
Recently, a very large analysis of research trials, called a meta-analysis, was published focusing on acupuncture for pain. The meta-analysis shows that acupuncture is effective for the treatment of pain. This was across many pain conditions including back and neck pain, osteoarthritis, chronic headaches, and shoulder pain.
Andrew Vickers PhD, the head author, and his team painstakingly reviewed virtually all of the acupuncture research trials which have focused on pain. They had strict criteria for the quality of the studies to be included in their analysis. In the end, the group used 29 acupuncture studies which included 17922 total patients.
The results of the study showed that acupuncture was much better than no-acupuncture control groups across the studies. The acupuncture was also better than placebo acupuncture across the groups. The difference between real and placebo acupuncture was not as large as the difference between acupuncture and no acupuncture. However, the numbers are large enough to show a real difference between placebo and real acupuncture for pain reduction.
May 14, 2012
Atopic eczema causes profound itching. Often the itching is the first sign of the condition and scratching leads to the inflammation.
A recent research report examined acupuncture treatment of itch in atopic dermatitis (1). This study was quite sophisticated. They compared acupuncture versus antihistamine treatment to reduce itching. They also compared acupuncture and antihistamine to an acupuncture and an antihistamine placebo. Finally, they looked at if acupuncture was better for preventing the itch or treating the active itching.
The acupuncture was stronger than the antihistamine in its ability to reduce itching. In fact, the acupuncture was the only clinically relevant reduction in the itch. While the antihistamine also reduced itch, it was not as strong as the acupuncture. Also, acupuncture did not have any cognitive adverse effects which were induced by the antihistamine.
Both the antihistamine and the acupuncture were stronger than their placebos.
Interestingly, acupuncture performed before the itching was induced was not as effective as acupuncture done after the patients were itching. So it is important to think about the timing when treating the itch.
How does acupuncture reduce itch?
The authors theorized that acupuncture reduction of itch may act through the similar pathways as pain reduction including the release of endogenous opioids and neurological pathways. Acupuncture may also reduce inflammation which is a significant in atopic eczema.
1. Pfab F, Kirchner MT, Huss-Marp J, et.al. . Acupuncture compared with oral antihistamine for type I hypersensitivity itch and skin response in adults with atopic dermatitis: a patient- and examiner-blinded, randomized, placebo-controlled, crossover trial. Allergy. 2012 Apr;67(4):566-73.
Nov 3, 2011
Acupuncturists have a choice in terms of how long the needles are left in the acupuncture points. Different times have different clinical effects.
Most often, the acupuncture needles are retained in the acupuncture points for 20-30 minutes. Traditionally we say it takes 30 minutes for the qi, the body’s energy, to circulate in the channels.
But if it is an acute situation, such as a back spasm, it is generally better to leave the acupuncture needles in for about 20 minutes. This is because the muscles will relax quicker in an acute injury like a back spasm.
When the energy is weak, what we call qi deficiency, it is better to leave the needles in for a longer period of time, such as 35 or 40 minutes in some cases. This provides and opportunity for the body to work on improving the energy.
When using electro-acupuncture, as I often do for pain, 20 minutes has been shown to be the optimal amount of time. In this case, I retain the acupuncture needles for 30 or 35 minutes total. The first 20 are with electro-acupuncture. The second I remove the electro-acupuncture and twirl the needles. The combination of electro-acupuncture stimulation and manual stimulation I find is effective at pain reduction.
Oct 28, 2011
Chronic pain is mysterious. It can come and go. It can get worse, or get better. Often without explanation.
Chronic pain is serious. It interferes with work, school, and relationships. Chronic pain is the most common issue that comes into my acupuncture clinic. Pain can effect almost any place in the body: headaches, back pain, shoulder pain, neck pain, knee pain, and any other location.
Acupuncture for Chronic Pain
Acupuncture is a complex therapy and works in a combination of ways to reduce pain and inflammation.
Acupuncture works to reduce pain and inflammation through regulating neural pain pathways, stimulating the release of natural pain relieves in the body, such as opioids, as well as regulating pain relieving opioid receptors.
Many studies have also shown acupuncture to have a anti-inflammatory effect, reducing the circulating inflammatory hormones in the blood, such as cortisol. Interestingly, many of the hormonal and neural effects last long after the acupuncture treatment has finished, suggesting that acupuncture has both immediate and long term regulatory effective in reducing pain.
What is the acupuncture needle doing?
We also can think about what the acupuncture needle itself is doing. When inserting a needle, the muscles near the acupuncture needle or along the acupuncture channel will often twitch. Many scientists have looked at this “twitch response” which can change the inflammatory mediators in the area of the acupuncture point. This could point to a mechanism related to local pain reduction.
Connective tissue stimulation is another possible mechanisms for pain relief that the acupuncture needle site.
Acupuncturists will twirl the needle many times during the treatment. Researchers have shown that this stimulates subcutaneous loose connective tissue. Helene Langevin, the remarkable researcher who discovered this, writes, “Fibroblasts (the cells) within the loose connective tissue respond to the mechanical stimulation with active cytoskeletal remodeling that may have important downstream effects within connective tissue.”
We do not know the specific clinical effects of the connective tissue responses. But Langevin believes these results may eventually lead to an explanation of the acupuncture channel circulation and connecting the body.
The next steps in acupuncture research will look to understand how these complex mechanisms work together for long lasting pain relief.
Napadow V, Ahn A, Longhurst J, et.al. The Status and Future of Acupuncture Mechanism Research. J Altern Complement Med. 2008 September; 14(7): 861–869.
Langevin HM, Churchill DL, Wu J. Et. al. Evidence of Connective Tissue Involvement in Acupuncture. FASEB Journal. April 10, 2002. Published Online.
National Center for Complementary and Alternative Medicine Website. Acupuncture for Pain. Accessed 4/30/2013.
Aug 25, 2010
The New England Journal of Medicine recently published an article on their blog in support of acupuncture for back pain. The authors, all respected and established researchers, carefully analyze the current situation with regards to back pain, and even though there is controversy in the research, recommend treatment.
Some skeptics are asking why would these scientists make a recommendation even though the research is unclear? The answer is easy, because it works and it is very safe.
The issue with the research was that the acupuncture group was not different from the placebo acupuncture group. But both the acupuncture and the acupuncture placebo groups were better than standard treatment. Yes, you read that correctly, the placebo acupuncture was better than conventional treatment.
The Ouch Point Dilemma
The placebo acupuncture treatment has been a pain for years. Study after study shows that acupuncture does not work better than the placebo. Yet, at the same time, both the acupuncture and the placebo have a clinical effect which is better than conventional treatment. Why?
First, there is the ouch point dilemma. Ouch points are points which are sensitive and tender when you press them. Often they are not classical acupuncture points, rather they are simply on the muscle in the area of the pain. When an acupuncture investigator selects points for the placebo treatment, they use points off of the standard acupuncture channels. Many of the non-channel point may be ouch points and may aid in the pain reduction.
Second, designing a placebo needle that does not have a physiological effect is very difficult. Often they use a needle with a retractable tip that does not puncture the skin. This is much like a magicians sword which retracts the blade as he stabs his assistant. Other needles may be light touch needle, or even toothpicks, that gently prick the skin. But this too may have a physiological effect. Some styles of acupuncture use this light tapping as a way to relieve pain.
In the end, acupuncture is a physical medicine. It is difficult to create a placebo intervention that does not have a physiological reaction with the body.
Because it is Safe
The researchers recommend acupuncture for back pain because it is safe and it works better than conventional treatment. Studies after studies show there is minimal risk of severe side effects. To those with back pain it does not matter if it works better than a placebo. They just need to feel better.
In my next articles, I will explain how acupuncture works to treat back pain.
Oct 15, 2008
The majority of Americans are in chronic pain or have experienced it. More and more, people are seeking acupuncture for relieve of all types of chronic pain, from back pain and neck pain, to headaches and migraines, or chronic pelvic pain.
Pain can affect almost every system in the body and develops from many sources.It can occur from a chronic immune disorder, after an infection, from a physical injury, or from emotional stress. Often, pain stays around a long time after an injury has healed.
As a teenager, I first sought out acupuncture to treat my own chronic pain. For several years I suffered from back pain. It was quite severe for my age, keeping me from playing sports, getting regular exercise, and fully enjoying myself. No one knew what it was from and everyone had their own theory: I was growing too fast, growing too slow, my muscle didn’t develop, or my muscles were too tight. After trying various remedies, and being called a complainer by my not so friendly general practitioner, I tried Chinese medicine. It was the only thing that stopped the pain.
How does Acupuncture address pain?
Acupuncture addresses pain by helping the body heal itself. It not only treats symptoms, like taking a painkiller, but also corrects imbalances in the body, thereby, allowing the body to heal itself.
Recently, several scientific studies have attempted to figure out what exactly this healing process is. To explain a few of the concepts, I’ll use my back pain as an example. Although, I feel the pain in my back, the perception of pain is created in the brain. Acupuncture works not only to heal the pain locally, in my back, but also in my brain. Unlike other approaches, acupuncture treats both sources of the pain.
Often, the acupuncture itself focuses on the location of the pain. In my case, it was the lower back.The fibroblasts, the cells of the connective tissue in the area, actually grab onto the needle.The ends of the cells then wrap themselves around the needle.[i] Then the cells begin to change shape and rearrange their own support system, probably working to correct injuries.This is also a method for cells to communicate with one another, so one cell can broadcast messages of self-healing to other cells in the tissue.[ii] In addition, the nucleus begins to expand, which signals the first stages of gene expression to repair the cell and the tissue around it.
The phenomenon in which the body grabs onto the needle has been known to Chinese medicine physicians for thousands of years and is described as “getting the qi” which should feel similar to a fish biting a hook. As a practitioner, this is how I know when the point is stimulated correctly. I can actually feel the body grab the needle, which tells me that the body is reacting well to the treatment.
Acupuncture Healing the Whole Body
While the acupuncture treatment may be focused on the painful area, the purpose of each acupuncture treatment addresses the whole body. As I mentioned before, one way acupuncture addresses the whole body is through the brain.
We forget a lot of things, like where we put your keys or our mother’s birthday. But, the brain does not like to forget pain. Often, the brain remembers pain long after an injury has healed itself. Using an fMRI scanner, a scan that tracks blood flow within the brain, scientists have shown that acupuncture can change the brain patterns for those with chronic pain.
One of the best studies that used fMRI focused on individuals with carpel tunnel syndrome.[iii]After the treatment, the pain was greatly reduced and the nerve health of the arm was improved. In addition, the carpel tunnel pain pattern within the brain was much more like that of a healthy person than before the treatment.
Working both at the area of pain and in the brain, acupuncture helps to reduce chronic pain by reteaching the body to be healthy.As we learn more about acupuncture we are also discovering how much the ancient clinical science of acupuncture and Chinese medicine has to add to our knowledge of the human body.
[ii] Langevin HM, Bouffard NA, Badger GJ, Et. al. SubcutaneousTissue Fibroblast Cytoskeletal Remodeling Induced by Acupuncture: Evidence for Mechanotransduction-Based Mechanism. J Cell Phys. 2006; (207): 767-774.