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Is Acupuncture Helpful in Chronic Pain Management

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DenpaNews Although acupuncture to treat chronic pain has become global, its use is still controversial and debated. Acupuncture is an alternative therapy originating from China which was discovered 4000 years ago where the method is to insert needles at certain points in the human body for health purposes, one of which is to treat chronic pain.[1,2]

Acupuncture

Acupuncture developed over time, acupuncture therapy long ago was known to focus on the flow of qi . As knowledge develops, acupuncture is becoming more modern, namely using the concept of stimulation and modulation of the nervous system through anatomically nerve points.[1,2]

Types of Acupuncture

There are several types of acupuncture used around the world, namely:

    • Traditional acupuncture, a technique known for a long time and only uses simple acupuncture needles.
    • Permanent acupuncture ( intradermal permanent needle acupuncture) , a technique that has a longer and permanent biostimulating effect on nerve points, is usually performed on patients who do not want repeated acupuncture such as in post-stroke rehabilitation , this technique uses a small needle for 2−3 days for biostimulation acupuncture poin.
    • Acupressure , a technique that stimulates acupuncture points with finger pressure
    • Laser acupuncture , a technique that uses monochromatic light, namely red light with a wavelength of 680 nm that enters muscle tissue as deep as 1.2 cm, was created by professor Mester Endre from Hungary and is widely used to relieve muscle pain and stiffness.
    • Epidermal needles for ear acupuncture or auricular semi permanent needles , ear acupuncture techniques used for 2-4 days only to avoid soft tissue damage.
    • Electroacupuncture (EA), a technique that combines traditional acupuncture with modern electrotherapy commonly used for stroke therapy, currently there is little scientific evidence that can show the effectiveness of this acupuncture therapy.
    • Massage technique with electrical instruments applied to acupoints, a special massage technique that combines electronic devices that are applied to acupuncture points[1,2,11 ]

Benefits of Acupuncture

Acupuncture is known to have physiologically relevant effects as analgesia, so it can be used to help reduce chronic pain. Acupuncture is believed to be beneficial for the following conditions:

    • Myalgia or pain in the back, shoulders, and arms
    • Chronic headaches, such as tension headaches
    • Knee pain caused by osteoarthritis
    • Pain caused by cancer
    • Abdominal cramps during menstruation or renal colic
    • Nausea, vomiting, or epigastric pain, eg in peptic ulcer and gastritis
    • Depression due to chronic illness, mood disorders , and sleep disorders
    • Leukopenia
    • Postoperative pain and nausea
    • hypertension Essential
    • Pain in the face, such as prospalgiam craniomandibular dysfunctions, temporomandibular joint disorders, and neuralgia[1,2,4,10]

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Chronic pain

Chronic pain is pain that is felt in > 1 part of the body and lasts > 3 months. Chronic pain can cause emotional and functional stress, resulting in disturbances in daily life. [1,7]

Chronic Pain Classification

Based on the WHO classification in the International Classification of Disease (ICD), chronic pain is divided into 7 categories, namely:

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  1. Chronic primary pain
  2. Chronic cancer related pain
  3. Chronic posttraumatic and postsurgical pain
  4. Chronic neuropathic pain
  5. Chronic headache and orofacial pain
  6. Chronic visceral pain
  7. Chronic musculoskeletal pain [7-9]

Chronic Pain Scale

There is a pain scale for chronic pain sufferers, known as the visual analogue scale (VAS). The VAS score was determined by measuring the distance between the ends of the line indicating the point of the painless area to the point of pain felt by the patient. Then the distance is matched with a 10 cm line table, with a scale reading of 0–100 mm. The determination of the VAS pain score is as follows:

    • No pain VAS : 0‒10 mm
    • Mild pain VAS: 11‒30 mm
    • Moderate pain VAS: 31–54 mm
    • VAS severe pain: 55–100 mm[7-9]

Etiology of Chronic Pain

Chronic pain can be caused by joint disorders such as osteoarthritis, back pain, headaches, muscle injuries, fibromyalgia , nerve damage, lymphatic disease, fractures, cancer, and surgery.[2,4,7-9]

The Importance of Alternative Therapies in Chronic Pain

Finding effective alternative therapies for patients with chronic pain is very important. An increase in the incidence of chronic pain is usually found with increasing age. The larger the population of elderly people, the more likely there are people with chronic pain. [3.11]

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Patients with moderate to severe chronic pain are usually treated with opioids. Increased use of opioids in chronic pain patients can lead to opioid dependence , and an increase in the number of deaths associated with the use of these opioids. In the United States there were more than 15,000 opioid-related deaths in 2015.[3,11]

Acupuncture Clinical Study of Chronic Pain

Vickers AJ et al in 2018 conducted a meta-analysis of a randomized controlled trial (RCT) examining acupuncture, versus sham acupuncture or no acupuncture. False acupuncture or sham acupuncture is pricking with a placebo needle. Trials were only included if the stabbing site was clearly hidden.[1]

This meta-analysis included 20,827 individuals from 39 RCTs. The research subjects were patients with nonspecific musculoskeletal pain, osteoarthritis, chronic headaches, or shoulder pain with pain duration of at least 4 weeks. The results measured were pain intensity and function monitored for 3−6 months.[1]

The results of this meta-analysis showed that acupuncture significantly (p < 0.001) could reduce or relieve chronic pain. In the group that received acupuncture, 50% of patients felt pain reduced or subsided, 42.5% in the fake acupuncture group, and 30% in the group without acupuncture. When viewed from a pain scale between 0 to 100, the patient’s pain scale in the acupuncture group was 30, the fake acupuncture group was 35, and the group without acupuncture was 43. [1]

The conclusion of the study is that acupuncture therapy is proven to help reduce chronic pain. However, this meta-analysis study has shortcomings and needs to be studied, namely:

    • There is no explanation regarding the type of acupuncture performed, such as traditional acupuncture or electroacupuncture
    • There is no standardization of the size of acupuncture needles and sham acupuncture
    • There is no explanation regarding the standard location of the acupuncture therapy points that are carried out, both for acupuncture needles and sham acupuncture
    • Lack of information regarding the duration of therapy using acupuncture needles compared to sham acupuncture
    • Some RCTs have a moderate to high risk of bias, namely sham acupuncture which has not been standardized in various studies, and studies comparing acupuncture with no acupuncture are clearly biased because they cannot be blinded by patients, doctors or researchers, and are not a robust research methodology [1 ]

A survey method study was conducted in 2017, with a subject of 55 patients who were asked to answer 12 questions related to their previous experience of acupuncture therapy. The study was conducted at an acupuncture specialist clinic in Skopje Macedonia.[6]

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There are 2 acupuncture needles used, namely cold needle acupuncture and fire needle acupuncture . The duration of cold needle therapy is about 30−45 minutes, and hot needle is about 5-10 minutes. Therapy once a week, as many as 10 sessions with a break of a month. In some severe chronic cases, therapy can be carried out >50 sessions. Questions asked included age, gender, disease symptoms, number of therapy sessions, and type and scale of pain.[6]

The results of the study were as many as 22 people (42.31%) stated that the pain had completely disappeared, 27 people (51.92%) said the pain had almost subsided, and only 3 people (5.77%) did not experience any improvement in their condition. This study has many biases, including a small number of subjects, only one study site, no control group, no blindness, and no methodological standardization.[6]

Considerations Before Doing Acupuncture Therapy

Junyi Wu et al . in 2015 conducted a systemic study of various scientific studies on acupuncture in China from 1980 to 2013. A total of 133 studies have been published, and information was obtained that acupuncture has various side effects ranging from mild to severe.[12]

Side effects of acupuncture therapy include pain during therapy, diarrhea, skin irritation, dizziness, headache, pneumothorax , central nervous system injury, peripheral nervous system injury, organ injury, muscle and soft tissue injury, syncope, infection, bleeding, and complications caused by a broken needle. [12]

In order to avoid unexpected events, acupuncture therapy should be carried out by experts or acupuncturist specialists. In addition, the hygiene factor of acupuncture equipment is very important to note. The acupuncture needles used must be properly sterilized or use disposable needles, so they do not cause infectious infections such as hepatitis B , hepatitis C , and HIV .[1,2,10,12]

Conclusion

Acupuncture therapy is still debated its usefulness for the treatment of various diseases, including the treatment of chronic pain. A 2018 meta-analysis of randomized controlled trials (RCTs) examining acupuncture, versus sham acupuncture or no acupuncture, suggests that acupuncture can reduce or relieve chronic pain. However, this study has many limitations, biases and still needs to be studied. The results of this study stated that 50% of patients with acupuncture experienced reduced pain, but 42.5% of patients with sham acupuncture also experienced pain relief. So that research is needed with a standardized and comprehensive methodology to be able to determine the effectiveness and safety of this method.[1,2,10,12]

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