The Management of Chronic Pain with Acupuncture

The use of acupuncture for pain control is less controversial. In 1973, the New York State Commission on Acupuncture summarized its recommendation as follows: “Acupuncture may bring partial or total relief from some acute or chronic pain conditions; it may restore to a healthful state in certain disorders; it can be in selected cases an advantageous source of relief from pain for surgical and dental procedures.” Unfortunately, most reports on pain control in large series of patients, to date, have appeared only in acupuncture symposia or in the “Letters to the Editor” columns of medical journals, so that the published data are scarce and are limited mostly to preliminary reports.

Summaries of work by several study groups at leading medical centers in the United States are available in the Proceedings of the National Institutes of Health’s Acupuncture Research Conference, held in 1973. For example, Beebe and associates at the University of Florida at Gainesville have achieved an approximate 50% relief of pain in 60% of their patients with various kinds of lower back problems. Chen of the California Medical Group reports excellent results in 68% of 14 patients with migraine, 10 patients with peptic ulcer, and 38 patients with other types of chronic pain. Approximately 68% of patients treated for pain by Kepes and colleagues, Montefiore Hospital and Medical Center in New York, were benefited initially by acupuncture therapy, and 46% were considered as improved at the time of discharge. Lee of the University of Florida at Gainesville studied pain control in 57 patients. Only 7 of the 44 patients who received traditional acupuncture obtained no relief of pain. In the remaining 13 patients, needle insertion was made at the accepted effective meridian points on one day and, on a subsequent day, completely arbitrary, unrelated points were used.

Pain relief was obtained in 10 of these latter patients when the correct meridian points were selected, but only 3 obtained some relief when the placebo points were used. Fifty patients with chronic pain of the neck, shoulder, back, hip, and knee due to osteoarthritis were studied by Matsumoto and colleagues at Hahnemann Medical College. Marked reduction of pain was noted in 80% of these cases, when the specific points were used, as opposed to no improvement in those patients in whom the “nonspecific” points were used. Sixty-nine patients with different pain syndromes showed a variety of responses to acupuncture at Temple University School of Medicine. Patients with shoulder pain did best, with 78% achieving relief. Of those with cervical pain, 45% responded compared to only 33% of those with lower back pain.

At Downstate Medical Center in New York City, Leung demonstrated improvement in the sciatica of 63% of 56 patients with disc problems and in 31% of 29 patients with osteoarthritis, following their first acupuncture treatment. Patients with disc problems tended to respond to acupuncture better than did those suffering from arthritis. The patients with disc problems who had not been operated on responded better than those who had undergone surgery. Although continued improvement was observed following multiple treatments, the most dramatic responses were often achieved after the first two or three. Over the past several years, 223 patients have been treated in 1,271 sessions at Downstate Medical Center’s Pain Clinic; an 82% improvement rate has been noted in patients with orthopedic problems and a 73% improvement rate in those with arthritis.

At the Columbia Presbyterian Medical Center Pain Clinic, 42 patients with migraine headaches of more than 2 years’ duration and averaging three attacks per week obtained a 55% partial relief of pain. Head points, such as Tai Yang (EM), Yin Tang (EM), and Feng Chih (207, GB 20), or extremity points, such as Ho Ku (84, CO 4), Wai Kuan (105, TH 5), Tsu San Li (178, ST 36), and San Yin Chiao (304, SP 6), were used. Teng obtained partial or complete remission of severe trigeminal neuralgia in 25 patients. Two-thirds of Teng’s patients had involvement of the mandibular branch of the trigeminal nerve, and one-third had involvement of the maxillary branch. Only a few patients had involvement of the ophthalmic branch. For neuralgia of the ophthalmic branch, Teng used a combination of two or three points: Tsan Chu (233, BL 2), Chu Cha (235, BL 4), Yang Pai (201, GB 14), Hsia Kuan (145, ST 7), and Yi Feng (117, TH 17). Points used for the maxillary branch were Szu Pai (144, ST 2), Chu Liao (145, ST 3), Chia Che (148, ST 6), Hsia Kuan (149, ST 7), and Yi Feng (117, TH 17), and for neuralgia of the mandibular branch, Ta Ying (147, ST 5), Chia Che (148, ST 6), Hsi Kuan (149, ST 7), Yi Feng (117, TH 17), and Feng Chih (207, GB 20).

Heller reports obtaining satisfactory results in seven cases of postherpetic neuralgia. Yue at St. Luke’s Hospital Center, New York City, reports obtaining satisfactory pain relief for a variety of acute and chronic conditions in approximately the same magnitude as the figures quoted earlier.
Chu reports treating 172 patients with painful disorders of the hip, including osteoarthritis (138), rheumatoid arthritis (11), following trauma or postsurgery (12), and arthralgia of unknown etiology (11). His results showed an average of 69.8% of patients achieving either complete or partial relief of pain. The points he used for painful hip were Chu Liao (216, GB 29), Huan Tiao (217, GB 30), and Feng Shih (218, GB 31).

Chu also reports on 65 patients with persistent low back pain and sciatica which did not respond to surgery. Of these, 54 completed acupuncture treatment but 11 did not. In this study, 6 patients were seen to have excellent results (11%); 14 good results (26%); 12 fair results (22%); and 22 poor or no results (41%). The points used by Chu for low back pain and sciatica were Shen Shu (254, BL 2 3), Yin Men (282, BL 37), Chih Pien (280, BL 54), Huan Tiao (217, GB 30), Feng Shih (218, GB 31), Yang Ling Chuan (221, GB 34), and local tender points. Chu investigated the use of acupuncture for relief of pain in cancer patients at Memorial Sloan-Kettering Cancer Center, New York City. Preliminary findings suggested that beneficial results can be obtained in some patients.

Several studies were initiated in the United States in the mid-1970s to evaluate objectively the effectiveness of acupuncture in the treatment of chronic pain. Levitt and Walker have reported obtaining relief of pain in 63% of their patients and functional improvement in 78%. A definite statistical significance was noted in the results obtained in the treated group as compared to the controls. There are no statistics available on results achieved in patients with intractable pain who did not respond to large doses of analgesics, narcotics, nerve blocks, or other conventional therapies, but did respond either temporarily or permanently following acupuncture treatment. A study undertaken by Smith at Massachusetts General Hospital showed morphine to be superior to acupuncture in the control of unbearable pain. Acupuncture, however, gave better results than either placebo acupuncture or saline injections. In a series of 18 patients with well-documented cases of intractable pain resistant to conventional therapy and treated by acupuncture by Mann, varying degrees of pain relief over periods ranging from hours to months were noted. Pain was considerably relieved in other patients for periods of 3- 72 hr. It has been estimated that 10% of the 110 ,000 physicians in Japan use acupuncture in their daily practice. In Sato and Nakatani’s  series of 97 patients with pain, 29 obtained complete relief and 3 obtained no relief.

It can be concluded that relief of pain by acupuncture, although temporary, may last for an indefinite period ranging from hours to weeks or even months, in contrast to the finite and predictable duration of pain relief obtained with the use of analgesics and nerve blocks. Repeat treatments are, of course necessary. What is required is a nationwide, critical review summarizing all these preliminary results in terms of success or failure, so that the potential usefulness of acupuncture in the control of pain can be evaluated in Western terms.

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