Acupuncture for Chronic Pain: Unprecedented Advances
SAN DIEGO — The last two decades have seen “unprecedented advances” in the use of acupuncture to treat pain conditions,
with a “rapid rise” in the number and quality of related published studies, according to a physician who
is an experienced acupuncture practitioner.
“Right now, we have a pretty solid foundation for the efficacy of acupuncture” for headache, osteoarthritis (OA), and
musculoskeletal conditions, said Farshad M. Ahadian, MD, clinical professor of anesthesiology,
University of California, San Diego.
“I think it’s fair to say that acupuncture is here to stay. It’s going to be a permanent addition to our tool box.”
Dr Ahadian presented the data here at the Academy of Integrative Pain Management (AIPM) 28th Annual Meeting.
Opioid Epidemic Rages On
To reach their “full potential,” clinicians need to “fully integrate” conventional medicine with alternative
therapies, which includes acupuncture, Dr Ahadian told meeting delegates.
This may be increasingly important because of two “really important critical challenges”:
the opioid epidemic and the aging population.
“The opioid epidemic has been raging for two decades, and there seems to be no end in sight.
And I don’t think we have woken up to the implications that an aging population has for the prevalence of chronic pain.”
“That underscores the powerful effect of placebo that is associated with any type of physical modality, including acupuncture,”
he said. He added that this presents “challenges for acupuncture research.”
The analysis also confirmed that acupuncture had “clinically meaningful effects, which is important,” said Dr Ahadian.
Clinically Meaningful Results
Other research has shown that acupuncture increases functional connectivity.
“Chronic pain can lead to abnormal patterns or disruption of functional connectivity in various brain centers,”
explained Dr Ahadian. He added that acupuncture “can help modulate and help normalize” functional connectivity.
He pointed to another study that included patients with moderate to severe knee OA who were acupuncture naive
and had not had any interventions in the prior 6 months. Patients were randomly assigned to receive
true acupuncture or sham acupuncture.
Each participant received six treatments over a 1-month period. They also underwent functional MRI.
Using the validated Knee injury and OA Outcome Score (KOOS), researchers found that the interaction between groups
(real vs sham) and time (baseline vs endpoint) was significant for the KOOS subscale scores
for pain (P = .025), function in sport (P = .049), and quality of life (P = .039).
The analysis demonstrated statistically significant improvement in functional connectivity in the right frontal
parietal network and the executive control network, “which are the brain centers that
are felt to play a significant role” in processing pain, said Dr Ahadian.
At the same time, there was decreased connectivity in the sensory motor network, he said.
“These are patterns that you would expect with improved pain control.”
The results were clinically meaningful, noted Dr Ahadian.
The study found that after treatment, the increase in functional connectivity was positively correlated with changes in KOOS pain scores.
In traditional Chinese medicine, pain and illness are believed to be caused by an obstruction to
the normal flow of qi (vital energy). It might be that functional connectivity is correlated to qi, said Dr Ahadian.
“Could it be that when we talk about removing these obstructions, what we’re talking
about is actually improving functional connectivity?”
Dr Ahadian stressed that finding effective alternative therapies to treat chronic pain is increasingly important in an era
characterized by skyrocketing opioid-related deaths. In 2015, there were 33,091 such deaths in the United States, he said.
Another factor that should stimulate the search for effective pain therapies is the growing elderly population.
The percentage of those aged 65 years and older was 13% in 2012 but expect to rise to 20% by 2050.
The incidence of chronic pain increases with age.
Training
In addressing a query from an audience member about training, Dr Ahadian referred him to the American Academy of Medical
Acupuncture (AAMA), the professional society of physicians who have incorporated acupuncture into their medical practice.
According to the AAMA website, membership requirements have establish in accordance with training guidelines created
by the World Health Organization–recognized World Federation of Acupuncture-Moxibustion Societies.
Other delegates were curious about the optimal number of acupuncture treatments and response times.
While some experts advise patients they need to try up to 20 treatments to know whether the treatment is working, “in my
experience, if you don’t have some positive response within maybe 4 or 5 treatments, you may need to
think twice,” said Dr Ahadian.
He noted that “not everybody is a great acupuncture responder.”
Certain factors may reduce a patient’s “acupuncture responsiveness. Acupuncture relies on an intact nervous system
to cause its effect, so if patients have significant peripheral neuropathy, or other neuropathies, they
may not be as responsive,” he said.
Once patients do respond, Dr Ahadian said he attempts to increase the interval between treatments while sustaining the results.
“Our goal in medicine is not to marry the patient to our office and have patients come in all the time,” he said.
“If I can’t get persistent efficacy, or reasonable efficacy, lasting a month, then I may advise against it or
I may need to figure out how to change my therapy.”
In a keynote address elsewhere at the AIPM meeting, retired US Army Colonel Gregory D. Gadson,
who lost both legs due to a roadside bomb blast while serving in Baghdad in 2007,
and now suffers chronic pain, said he still receives occasional “battlefield acupuncture.”
When asked by Medscape Medical News about “battlefield acupuncture,” Dr Ahadian explained that it involves a brief session
using small needles in the skin of the ear to block pain. The treatment can administer in
as little as 5 minutes and is being used to treat wounded US service members.
Dr Ahadian reports that he receives principal investigator research support from Boston Scientific and Mainstay Medical.
Academy of Integrative Pain Management (AIPM) 28th Annual Meeting. Presented October 22, 2017
