Acupuncture and Pain
Acupuncture may be one of the better known nonpharmaceutical approaches for treating pain associated with spinal cord injury. Acupuncture may be one of the better known nonpharmaceutical approaches for treating pain associated with spinal cord injury.
There are many non-pharmaceutical approaches for treating spinal-cord-injury (SCI) associated pain, and acupuncture
may be one of the better known methods for helping improve those discomforts.
Traditional Chinese Medicine believes a life-force energy permeates our bodies through meridians punctuated by acupuncture points. Think of the meridians as a pipeline through which life-force energy flows and the points as periodically placed, flow-controlling valves.
It’s kind of like acupuncture needles are socket wrenches that open these valves, promoting health-enhancing energy flow.
Evidence indicates acupuncture may actually restore some function after SCI. Some studies suggest it helps by stimulating the expression of regenerative stem cells.
Acupuncture influences pain-processing neural pathways and neurotransmitter systems, which, in turn, affects the release of pain-reducing molecules and hormones. It has been extensively used by the general population to treat pain and may also reduce SCI-associated pain.
A Decrease in Pain
Many studies have been done on using acupuncture to treat SCI pain, and several have shown interesting results.
The governor meridian is a central point for many acupuncture treatments.
A 2001 study led by Sangeetha Nayak, PhD, from the New Jersey Medical School, treated 22 individuals with SCI and pain with 15 acupuncture sessions over a 7½-week period. In each session, six to 14 acupuncture points were needled, including a key point located in the governor meridian (see figure) between the C7 and T1 vertebrae.
Subjects rated their pain intensity using a zero (no pain) to ten (worst possible) pain scale. Average pain decreased from 6.9 before to 5.4 after treatment, a reduction that persisted for some time.
The more responsive subjects tended to have pain located above the injury, incomplete injuries, or musculoskeletal pain.
A 2003 study looked at adding a bit of electrical stimulation to acupuncture.
Linda Rapson, MD, from the Toronto Rehabilitation Institute, and colleagues used electro-acupuncture to treat SCI-associated neuropathic pain. Specifically, electrically stimulated acupuncture needles were inserted in three points farther up the governor meridian on the scalp midline and a fourth point located between the eyebrows.
Patients were initially treated five times a week, and treatment was continued until full pain relief was obtained or no further benefits accrued.
The investigators retrospectively reviewed the medical charts of 36 patients with spinal-cord dysfunction (22 with traumatic injuries) and pain treated with electro-acupuncture over a five-year period. Of these patients, 24 benefited from treatment, including 18 who experienced pain relief after only one treatment.
A Two-Pronged Study
Shoulder pain always seems to be a big issue with wheelchair users, and a 2001 study looked at two ways to make things better.
Trevor Dyson-Hudson, MD, from the Kessler Institute for Rehabilitation, and colleagues evaluated the use of acupuncture or bodywork to treat shoulder pain in manual-wheelchair users.
Subjects received ten acupuncture or bodywork sessions over five weeks. In each acupuncture session, various points associated with upper-extremity pain and areas of tenderness were needled.
During the bodywork sessions, gentle motions were used to loosen joints, ease movement, and release chronic-pain patterns.
Pain was assessed using “The Wheelchair User’s Shoulder Pain Index” (WUSPI), in which subjects rated shoulder pain for 15 activities of daily living using a zero (no pain) to ten (worst possible) scale for each activity.
The scores for all activities were combined into a single 0–150 score. By the end of the treatment period, pain levels had decreased 54% for the acupuncture- and bodywork-treated individuals.
A Sham Study
Because this study didn’t have a placebo control group, researchers initiated a somewhat similar investigation in 17 subjects with shoulder pain randomized to receive ten sessions of active or sham acupuncture. With the latter, putatively inactive areas near the true acupuncture points are needled.
Using the WUSPI, shoulder pain in acupuncture-treated subjects decreased 66% compared to 43% for the sham-treated individuals. Seventy-five percent of the acupuncture-treated individuals reported a clinically meaningful reduction in pain after five weeks of treatment compared with only 25% for the sham-treated individuals.
The investigators noted the use of sham acupuncture points is problematic because they are not neutral controls. Although not as effective as true acupuncture points, sham points also evoke physiological responses through different mechanisms.
More recently, research in 2011 from Cecilia Norrbrink and a group from the Karolinska Institutet in Stockholm treated 30 individuals with SCI and neuropathic pain for six weeks with either twice-weekly acupuncture or massage therapy.
In each acupuncture session, 13–15 acupuncture points were needled, including several points stimulated by electro-acupuncture. The investigators used a zero (no pain) to 100 (holy cow!) scale to assess “general pain” and “pain unpleasantness” experienced during the last week, as well as “present pain.”
Specifically, general pain decreased from 63 to 48 after treatment, pain unpleasantness decreased from 70 to 47, and present pain decreased from 59 to 40. Smaller declines were observed for the massage group.
Worth a Look
Many pharmaceutical or surgical approaches used to treat SCI-associated pain have serious, health-compromising side effects and are only marginally effective over the long term. Although not a remedy for pain, acupuncture is a side-effect-free, nothing-to-lose approach that may reduce quality-of-life-compromising pain.