Is Acupuncture for Chronic Pain a Viable Option?

The treatment of chronic pain has always been a major focus of modern medicine. While acute pain can and is often treated with drugs, chronic pain presents other challenges. For example, long-term use of certain pain-management drugs can be damaging to the liver and kidneys, making treatment a challenge.

Experts do agree that one of the best ways of living with chronic pain is to adopt a multi-modal approach. That means blending together a series of therapies and treatment modalities to get the best results faster. One of the modalities with a long tradition is the use of acupuncture for chronic pain.

A recent paper – which looked into earlier studies involving acupuncture and pain — published by the by the North Carolina Medical Journal might change that. According to the authors of this study, acupuncture has been shown more times than not to provide relief in the four major areas of pain: chronic headaches, chronic shoulder pain, chronic back and neck pain, and osteoarthritis.

The Major Factors

One of the factors affecting the outcome of studies regarding acupuncture for chronic pain is the “sham acupuncture” control group. Sham acupuncture is used to refer to the application of needles at a superficial level and at points that have no known therapeutic value (instead of applying the needles to recognized energy points).

When researchers compared the results of using traditional acupuncture and sham acupuncture, they noticed that in many studies (but not all studies), people in both groups experienced an improvement in their pain level and frequency. This raises an interesting question for researchers: is the simple action of using needles enough to alleviate pain or is there a placebo effect in place when using acupuncture?

Researchers believe the answer might lie somewhere in between, especially considering the long tradition of acupuncture being used effectively to treat a number of conditions.

Why Try Acupuncture

The evidence is clear and compelling that acupuncture is very effective for treating many forms of chronic pain, even if the question of how much of this effectiveness is due to placebo effects has not yet been settled. Another factor to consider is acupuncture’s low incidence of side effects. The study notes that significant side effects occur at “an incidence of 1 or 2 events per 34,407 treatments.” When compared to the side effects other forms of treatment carry, acupuncture can be considered to be a relatively very safe option.

A Final Word

While acupuncture alone might not be enough to control severe chronic pain, combining it with other forms of therapy could provide excellent results – and in more ways than one. For example, research shows that patients taking opioids for pain experience fewer side effects (which include nausea, sedation and dizziness) from the drug when using acupuncture at the same time.

In the end, researchers believe that when faced between the choice of using acupuncture or no treatment at all to address chronic pain, acupuncture can provide a number of benefits. However, more research is needed to better establish acupuncture’s place in the treatment of chronic pain.

Is Acupuncture for Menopause a Suitable Treatment for Hot Flashes?

Hot flashes have always been one of the major complaints in peri- and postmenopausal women. Modern medicine addresses hot flashes by suggesting the use of a number of drugs, including some designed specifically for hot flashes and some being prescribed off label. And many women simply learn to understand what are hot flashes and live with them as something inconvenient that is part of growing older.

But it doesn’t have to be that way. In fact, complementary and alternative medicine (CAM) can offer a number of solutions to a problem that has plagued women for centuries – and, even better, offer solutions that are not invasive and with few side effects. One of those options is using acupuncture for menopause to ease the intensity and frequency of hot flashes.

An Interesting Study

In a study published on Menopause: The Journal of The North American Menopause Society, a group of researchers from UNC Chapel Hill and Wake Forest University (Drs. Remy Coeytaux, Wunian Chen, Nancy Avis, and others) set out to examine the effect of acupuncture for menopause on the frequency and severity of hot flashes. To do this, they enlisted the help of 56 women under the age of 56 who had already stopped menstruating and were experiencing at least four hot flashes on an everyday basis.

The women were divided into three groups, with the first group considered the control group:

The women in the first group were told to continue whatever they were previously doing to treat their hot flashes.
A second group received Traditional Chinese Medicine (TCM) acupuncture, where needles were inserted in specific treatment points twice a week for eight weeks. The treatment points were meant to control night sweats, balance out yin/yang and improve kidney function (which acupuncturists believe is connected to hot flashes).
The third group received something labeled as “sham acupuncture.” That meant needles were inserted only shallowly at sites that have no connection to hot flashes and were not expected to produce any results.

The Results Were Surprising

That’s because women in both groups Two and Three experienced improvement. This was a surprising development, since the third group wasn’t receiving traditional acupuncture for menopause.

Still, when women were asked to track the frequency and severity of their hot flashes after starting treatment, both groups reported improvement. In fact, the study showed that women in both acupuncture groups were experiencing 40 percent fewer hot flashes after the third week. They also mentioned better sleep, a positive change in mood, more overall energy, and less anxiety.

What does this mean? Researchers involved with the study believe it could mean two things. One is that the simple act of inserting needles could provide some relief for hot flashes, even if the needles are not inserted at traditional points or deep enough to cause energy movement.

The Placebo Effect

Another possible explanation is that there’s a strong placebo effect in place when using acupuncture for menopause. This could explain why even needles not associated with hot flashes points still produced a beneficial effect. The simple act of receiving acupuncture was relaxing enough and effective enough to induce positive changes in the women going through treatment.

More Research is Needed

Experts do agree that further research is needed to get deeper into the effects of using acupuncture to treat menopause issues, including hot flashes. The same researchers have since conducted a much larger clinical trial sponsored by the National Institutes of Health (NIH). The acupuncturists for that more recent study included Drs. Wunian Chen and Helen Wang from Acupuncture Balanced Health. Dr. Remy Coeytaux, also from Acupuncture Balanced Health, was one of the principal investigators. The results of this larger study will be published soon (spoiler alert—the women who received acupuncture experienced highly significant decrease in hot flash frequency and severity within 4 weeks of starting a course of acupuncture treatments).

Acupuncture for Depression

This month’s edition of the magazine, Scientific American, includes a well-written and informative discussion about the evidence in support of acupuncture’s effectiveness in the treatment of Major Depression. This article also provides a good overview of the challenges associated with clinical trials of acupuncture for depression.

As summarized in the Scientific American article, several published studies have demonstrated that acupuncture can be helpful in the treatment of depression. One of the most important studies was conducted by Dr. Hugh MacPherson and colleagues in England. They randomized 755 patients with depression to one of three treatment groups: 1) acupuncture plus usual care; 2) counseling plus usual care; or 3) usual care alone. They found that both acupuncture and counseling were associated with significantly reduced depression compared to usual care alone.

Another randomized clinical trial found that acupuncture in combination with the antidepressant medication paroxetine (Paxil) was more effective at improving symptoms than Paxil alone after 6 weeks of treatment. Yet another study demonstrated that a 6-week course of acupuncture alone was as effective as a course of treatment with the antidepressant medication fluoxetine (Prozac).

In addition to being effective as either a stand-alone or adjunct treatment for depression, acupuncture may be used to alleviate some of the symptoms associated with commonly used medications for depression. A recent study reported “Significant improvement among male participants was noted in all areas of sexual functioning, as well as in both anxiety and depressive symptoms. Female participants reported a significant improvement in libido and lubrication and a nonsignificant trend toward improvement in several other areas of function.” (Reference: Khamba B et al. Efficacy of acupuncture treatment of sexual dysfunction secondary to antidepressants. J Altern Complement Med. 2013; 19(11):862-9).

In my view, acupuncture is not likely to be sufficiently effective to serve as one’s only treatment for depression, but the evidence strongly suggests that acupuncture can play an important and positive role in the treatment of Major Depression and other clinical conditions in which depressed mood and other symptoms commonly associated with depression feature prominently.