Musculoskeletal Pain and Dysfunction
The value of acupuncture in the control of painful conditions is fairly well-established in the medical literature. This almost certainly involves the ability of acupuncture (through some poorly understood mechanism) to trigger the release of endorphin, enkephalin and other pain-modulating chemicals in the central nervous system.
Specifically, acupuncture has been shown to be effective in the treatment of chronic pain in a number of areas of the musculoskeletal system, including the lower back, the elbow, the neck, the shoulder, the hip and the knee. Acupuncture appears to be equal in effect to more conventional therapies (steroid injections, NSAIDs, ultrasound) and has a noticeable lack of side-effects (Berry et al 1980). Acupuncture can also be used in the short term for acute pain, such as that in the back, and may be the preferred form of therapy when muscle spasm is present. Acupuncture can be used to relieve stiffness and has been shown to increase significantly the range of movement of knees joints of patients with severe osteoarthritis.
Neck pain is an area which generally responds very favorably to acupuncture treatment. A randomized clinical trial published in the July 2003 issue of the journal Spine compared medication, acupuncture, and spinal manipulation for spinal pain. Of the three, acupuncture had the best results on the VAS (pain scale) for cervical spinal pain (Giles & Muller, 2003).
Furthermore, numerous studies have shown that acupuncture can reduce the overall burden of symptoms in painful conditions by improving muscle spasm, sleep pattern, depression, anxiety and restlessness. Empirical evidence suggests that the autonomic nervous system may play an important but poorly understood role in maintaining a number of chronic pain systems. As the successful use of acupuncture for nausea and vomiting demonstrates, acupuncture can have a normalizing effect on autonomic dysfunction. Acupuncture can be used to treat fibromyalgia, chronic fatigue, irritable bowel syndrome, and similar pain syndromes that seem to be related to nervous system dysfunction, such as reflex sympathetic dystrophy (RSD).
Thomas, M., Lundberg, T., (1994) Importance of modes of acupuncture in the treatment of chronic nociceptive low back pain. Acta Anaesthesiol Scand 38(1):63-9. 40 patients with chronic nociceptive low back pain were randomized to 3 different acupuncture treatments and a control group. At 6 weeks, all acupuncture treatment groups showed significant improvement in motility, pain descriptors and subjective assessment. At 6 mos., a significant improvement was present in patients receiving low frequency (2 Hz) electrical acupuncture.
Macdonald AJ, Macrae KD, Master BR, Rubin AP. Superficial acupuncture in the relief of chronic low back pain. Ann R Coll Surg Engl 1983 Jan;65(1):44-6
Molsberger, A., Hille, E., (1994) The analgesic effect of acupuncture in chronic tennis elbow pain. Br J Rheumatol 33(12):1162-5. 48 patients with tennis elbow pain were randomized to acupuncture or placebo groups. The acupuncture treatment groups reported significantly more pain relief and greater analgesia durations.
Yeung CK, Leung MC, Chow DH. The use of electro-acupuncture in conjunction with exercise for the treatment of chronic low-back pain.J Altern Complement Med 2003 Aug;9(4):479-90. "OBJECTIVES: To determine the effect of a series of electro-acupuncture (EA) treatment in conjunction with exercise on the pain, disability, and functional improvement scores of patients with chronic low-back pain (LBP). DESIGN: A blinded prospective randomized controlled study. Subjects and interventions: A total of 52 patients were randomly allocated to an exercise group (n = 26) or an exercise plus EA group (n = 26) and treated for 12 sessions. OUTCOME MEASURES: Numerical Rating Scale (NRS), Aberdeen LBP scale, lumbar spinal active range of movement (AROM), and the isokinetic strength were assessed by a blinded observer. Repeated measures analysis of variance (R-ANOVA) with factors of group and time was used to compare the outcomes between the two groups at baseline (before treatment), immediately after treatment, 1-month follow-up, and 3-month follow-up. The level of significance was set at p = 0.05. RESULTS: Significantly better scores in the NRS and Aberdeen LBP scale were found in the exercise plus EA group immediately after treatment and at 1-month follow-up. Higher scores were also seen at 3-month follow-up. No significant differences were observed in spinal AROM and isokinetic trunk concentric strength between the two groups at any stage of follow-up. CONCLUSIONS: This study provides additional data on the potential role of EA in the treatment of LBP, and indicates that the combination of EA and back exercise might be an effective option in the treatment of pain and disability associated with chronic LBP."
Berry H, Fernandes L, Bloom B, Clark R, Hamilton E 1980 Clinical study comparing acupuncture, physiotherapy, injection and oral anti-inflammatory therapy in shoulder cuff lesions. Current Medical Research and Opinion 7:121-126.
Moore M F, Berk S N 1976 Acupuncture for chronic shoulder pain. Annals of Internal Medicine 84:381-384
Peng A T, Behar S, Yue S 1987 Long-term therapeutic effects of electroacupuncture for chronic neck and shoulder pain -a double blind study. Acupuncture and Electrotherapeutics Research 12:37-44
Christensen B, luhl I, Vilbek H, Bulow 11, Dreijer N, Rasmussen H 1992 Acupuncture treatment of severe knee osteoarthrosis. A long-term study. Acta Anaesthesiologica Scandinavica 36:519-525
Takeda W, Wessell J 1994 Acupuncture for the treatment of pain of osteoarthritic knees. Arthritic Care and Research 1:118-122
Mclndoe A K, Young K, Bone M E 1995 A comparison of acupuncture with intra-articular steroid injection as analgesia for osteoarthritis of the hip. Acupuncture in Medicine 13:67-70
Puett D, Griffin M 1994 Published trials of non-medicinal and non-invasive therapies for hip and knee osteoarthritis. Annals of Internal Medicine 121:133-140
Haslam R. A Comparison of Acupuncture with Advice and Exercises on the Symptomatic Treatment of Osteoarthritis of the Hip – A Randomised Controlled Trial. Acupuncture in Medicine. 2001;19(1):19-26. CONCLUSIONS: “acupuncture is effective in treating the symptoms of OA of the hip with patients waiting for a total hip arthroplasty and that such benefits can last for at least two months post-treatment.”
McIndoe AK, Young K, Bone ME. A Comparison of Acupuncture with Intra-articular Steroid Injection as Analgesia for Osteoarthritis of the Hip. Acupuncture in Medicine. 1995;8(2): p.67. CONCLUSIONS: “Periosteal acupuncture appears to be as effective as an intra-articular injection in relieving the pain associated with osteoarthritis of the hip.”
Molsberger AF, Mau J, Pawelec DB, Winkler J. Does acupuncture improve the orthopedic management of chronic low back pain--a randomized, blinded, controlled trial with 3 months follow up. Orthopedic Surgery and Research, Kasernenstr 1b, 40213, Dusseldorf, Germany. molsberger@t-online.de. Pain. 2002 Oct;99(3):579-87. Prospective, randomised controlled trial, with three parallel groups, patient and observer blinded for verum and sham acupuncture and a follow up of 3 months. 174 patients met the protocol criteria and reported after treatment, 124 reported after 3 months follow up. CONCLUSIONS: Our conclusion is that acupuncture can be an important supplement of conservative orthopedic treatment in the management of chronic LBP.
Giles LG, Muller R. Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation. Spine 2003 Jul 15;28(14):1490-1502.
PMID: 12865832
|
