Acupuncture in the Treatment of Pain

Abstract

D uring the several-thousand-year history of which conditions and to what extent it is efacupuncture in Asia, a major apphcation fective, this has not been easily gained. Many has been the treatment of a broad range of pain complex problems have been confronted, not conditions. The modern era of acupuncture, the least of which has been the difficulty of concomprising the past two decades, has thor-ducting controlled clinical trials of acupuncoughly documented the safety and effective-ture. While researchers have attempted to folness of acupuncture analgesia for the treatment low a double-blind, placebo-controlled model of chronic and acute pain. Extensive clinical when testing acupuncture, this approach has and laboratory research has validated its use, raised numerous problems and has left many and detailed biomedical models have been pro-questions unanswered. Two of the difficulties posed to explain its action.immediately encountered were the virtual imAfter Nixon opened China to the West in possibility of blinding the acupuncturist (simi-1971, acupuncture became very popular as an lar to the problem of blinding a surgeon when alternative therapy for the treatment of pain testing a new procedure) and the uncertainties conditions. The international medical commu-inherent in choosing control acupuncture nity was startled, if not guardedly amazed by points. Inadequate solutions to these methodthe films of surgery on awake patients who ap-ological problems have often resulted in clinipeared to receive acupuncture analgesia in cal trials of questionable quality. Thus, when place of normal pharmaceutical anesthesia, reviewing an acupuncture efficacy trial with a This amazement was rapidly channeled into a reported negative outcome, it is critical to deconcerted research effort to understand how termine the extent to which the outcome was these surgical anesthesias were possible and due to poor study design rather than to an acthence to investigate the physiological mecha-tual failure of acupuncture to ameliorate the nisms by which acupuncture relieves pain, condition (see the paper of Lewith in this issue Many theories were put forward and tested, of the journal). Despite these considerable and many clinical trials were conducted to ex-problems, results indicating the efficacy of plore these questions. During the past 20 years acupuncture as an analgesic therapy have been or so, a growing database of clinical trials has found in a significant number of studies, for a produced a clear picture of how effective broad range of pain conditions. In this article, acupuncture can be for human and veterinary we discuss the following: treatment of a variety of pain conditions. Although the evidence has been building as to • Animal studies exploring mechanisms of achow acupuncture treats pain conditions and for tion of acupuncture as an analgesic therapy;

Acupuncture and Amitriptyline for Pain Due to HIV-Related Peripheral Neuropathy<SUBTITLE>A Randomized Controlled Trial</SUBTITLE>

“…28 There is controversy over what constitutes an acceptable control group for acupuncture studies. 8,29 It is possible that the novelty of an experience like acupuncture may generate a placebo analgesic effect quite apart from specific effects produced by needling specific points. 30 Unless the study includes a "sham" acupuncture group as a control, such nonspecific effects may bias toward a result in favor of the active intervention.…”

“…Amitriptyline is frequently prescribed for neuropathic pain and has been shown to be an effective treatment for diabetic, hereditary, toxic, and idiopathic neuropathies. 6,7 Although several trials that reported examining acupuncture for chronic painful conditions claim efficacy, 8,9 these studies have methodological limitations, including small sample sizes and inadequate controls for the nonspecific effects of acupuncture. [9][10][11] Meta-analyses of studies of acupuncture for chronic pain show a response rate of approximately 70% for acupuncture, 50% for "sham" acupuncture (needling points not considered effective), and 30% for control treatments, such as sham transcutaneous electrical nerve stimulation.…”

Clinical Research on Acupuncture: Part 2. Controlled Clinical Trials, an Overview of Their Methods

“…Many studies appear to have administered inadequate treatment in terms of number of treatment sessions, number of points used, specific points used (Birch, 1995a(Birch, , 1997a(Birch, , 2003aBirch and Felt, 1999). Ensuring that an adequate and proper treatment is administered is not an easy problem to solve, in part because of the diversity found in the field (Birch, 1998;Birch and Felt 1999;Birch and Sherman, 1999;MacPherson and Kaptchuk, 1997). It is essential in future clinical trials of acupuncture that realistic and viable solutions are found (Birch, 2001a;Molsberger et al, 2002;Sherman and Cherkin, 2003;Stux and Birch, 2001;White, 2002).…”

“…The necessary qualifications need to be carefully established and fully stated (MacPherson et al, 2002b). International standards could be developed to set a minimum training requirement for acupuncturists who participate in acupuncture research studies, this is a complex area due to variation in training standards in different countries (Birch and Felt, 1999;Stux and Birch, 2001). Another important aspect of establishing the qualifications of the participating acupuncturist(s) in a study is to train them specifically for the study (Schneyer and Allen, 2002).…”

“…These include issues in publications, definitions, conceptual frameworks, and diversity of practice in the field, and their potential impact on clinical research (Birch 1994(Birch , 1995b(Birch , 1998(Birch , 2003cBirch and Felt, 1999;Birch and Kaptchuk, 1999;Birch and Tsutani, 1996, * problems in the matching of study design to research questions (Birch 2002b(Birch , 2003a(Birch , 2003b, problems and solutions in the adequacy of treatment in acupuncture clinical trials (Birch 1995a(Birch , 1997a(Birch , 2003aStux and Birch 2001), * problems and solutions in the use of sham acupuncture methods and controlling for the nonspecific effects of treatment Birch, 1995aBirch, , 1997aBirch, , 1997bBirch, , 2003aBirch and Jamison, 1998;Birch et al, 2002;Margolin et al, 1995Margolin et al, , 1997bStux and Birch, 2001), * methods of locating and testing treatment and sham acupuncture points (Falk et al, 2000;Margolin et al, 1995Margolin et al, , 1997b, problems and solutions in the testing of traditional forms of acupuncture (Birch, 1997cMacPherson et al, 2002a), validating diagnosis and treatment selection in traditional forms of acupuncture (Birch and Sherman, 1999;MacPherson et al, 2002a), * problems in the interpretation of clinical trials and systematic reviews of acupuncture (Birch 2000(Birch , 2001a(Birch , 2001b(Birch , 2003aBirch et al, 2004;Ezzo et ...…”