Collaborative Writing by Marianne Pierce

Let’s consider, for a moment, hangnails. They’re about the least medically threatening thing on the planet, but when you get a bad one, it can be hard to think of anything else. You might be at work, or studying for a test, or taking care of your kids, but your focus isn’t what it should be, because your mind is on the pain emanating from your finger. Rationally, you know there’s nothing life-altering happening, that the pain will soon go away – and yet…it takes your whole focus. Pain isn’t just physical, it’s psychic.

The hangnail allows us to put things into perspective. Now, imagine pain that’s ten times worse. Pain that disrupts your daily living thoroughly, that makes it hard to walk, to do chores, to fulfill your basic needs. This may lead you to a state of depression which exacerbates the pain. You may experience panic attacks or you might turn to drugs and alcohol just to get by. Now picture this: your doctors (you’ve been to many) can’t find the source of the pain though they’ve examined you from head to toe. They offer you painkillers but with all the news about opioid addiction ravaging the nation, do you agree to take them? 

For many, this isn’t a mental exercise, it’s the stark reality facing them each and every day. That’s why it’s incumbent upon us to create multifaceted, varied, and holistic approaches to pain management; approaches that take into account the mind, body, and spirit. Acupuncture is purported to be one piece of this puzzle but what does the science say?

A study published by JAMA Internal Medicine on October 22, 2012, gives an emphatic yes. The study consisted of a meta-analysis of almost 18,000 patients from high-quality RCTs. The researchers found that acupuncture was superior to both sham acupuncture and no acupuncture treatments for back and neck pain, osteoarthritis, and chronic headaches. The study sought to learn about the effects of shoulder pain, but there were insufficient high-quality RCTs to come to a conclusion. That said, acupuncture seems to have general analgesic effects and its low-risk means one should not be deterred from making a referral. The study concluded that acupuncture is a reasonable referral option for pain management.

We can safely say that acupuncture is more effective than sham treatment for pain management, but what about acupuncture versus medication? Before we delve into that point, it’s worth circling back to something discussed earlier – the problems inherent in medicating for pain. Many chronic pain sufferers are loathe to turn to stronger medications like opioids for fear that those drugs will disrupt their lives as much, or more, than the pain itself.

A study published in The Clinical Journal of Pain (February 2013 – Volume 29 – Issue 2 – p.172–185) reports on acupuncture’s effectiveness in treating lower back pain. The study, which conducted a meta-analysis of 11 RCTs (with a total of 1139 patients), found that acupuncture may be more effective than pain NSAIDs for LBP symptom improvement. Evidence that acupuncture is more effective than NSAIDS for LBP pain relief is less consistent,  however, it is more effective than sham acupuncture, consistent with the finding in the previous study. The authors conclude that the evidence is encouraging and more studies are needed.

That last sentence is one you’ll read a lot if you do research into acupuncture and it’s one that, frankly, has become tiring to see. We keep being provided with evidence that acupuncture is an effective pain management tool, but researchers remain reluctant to study it. There’s evidence that it could help with all kinds of pain management: arthritic pain, pain caused by bruxism, migraine headaches, and more. This isn’t to say you shouldn’t see your dentist if your jaw is clenching or that you shouldn’t get an eye exam if you’re experiencing ocular migraines. Rather, it’s to question why these studies aren’t available.

Here we enter into the realm of speculation, but allow me to offer a couple of points which I think are salient. The first is that there is a lack of understanding about the mechanisms by which acupuncture relieves pain. We’ve theorized that it might be because it stimulates the production of natural analgesics or that it helps increase circulation to affected areas.  There is no conclusive evidence for why acupuncture works for pain management, however – only that it does. In this way, it’s much like chronic pain itself –  the effect is clear, the cause, murky. Why, then, do we know acupuncture is effective to begin with?

This is where the second reason I imagine acupuncture is understudied comes into play; the practice came into existence thousands of years ago and it’s an important part of Traditional Chinese Medicine (TCM). Western scientists seem reluctant to study TCM, and it can be dismissed as quackery, even though high quality meta-studies show it’s effective for pain management. This strikes me as an absurd tragedy, one that is being produced by a fear of the unknown or a shunning of what is perceived as mysticism.

The reality is, acupuncture is an extremely low-risk and viable option for pain management and should be recommended as a part of a holistic pain treatment plan. Acupuncture may work by activating the body’s natural healing abilities and promoting physical and emotional well-being. The second part is key, as it’s well established that managing emotional responses to pain is critical to managing the pain itself. A professional certified acupuncturist will take many things into account when treating a patient: their emotional state, where they are experiencing pain, their medical history, and more. You must find a professional certified acupuncturist for these benefits; because as we’ve discussed, sham acupuncture is not effective while acupuncture from someone who isn’t certified may lead to serious complications. Try acupuncture and take control of your pain.