Acupuncture versus Medication for Pain Management
Which is the best approach long-term for chronic pain?
Chronic pain is a common and distressing complaint that has negative long-term implications for both the person experiencing the pain and on society.
The Global Burden for Disease study in 2016 confirmed that chronic pain and pain-related diseases are the leading cause of disability and disease burden globally.
Due to the high prevalence of chronic pain in the US and the reliance on medication for pain relief, many states have implemented strategies to curb opioid use and instead promote acupuncture as a natural way to manage pain.
This article looks at the use of acupuncture versus medication for pain management to determine the best approach for chronic pain long-term.
What causes pain?
Pain is an unpleasant sensation that is initiated by the nervous system in response to tissue damage, illness, nerve damage or non-tissue factors such as psychological and social factors (memories, fear, anxiety, avoidance, feelings of loss, guilt). The body’s pain system is highly complex and pain often has multiple causes.
Pain is the body’s alert system and should not be ignored; it’s a warning sign that something is wrong and needs investigating, whether that be a damaged tissue or an emotional disturbance.
Individuals respond to pain differently and pain sensitivity (how someone experiences pain) can change with the feelings and thoughts that coincide with the pain. A person’s past experience with pain, their expectations and belief systems around pain, and their emotional state when the pain is experienced (stress can lower your pain threshold) also play a role in how they react to pain.
Common causes of pain include:
An injury – strains, fractures, bruises
Cuts, bruises and burns
Conditions such as osteoarthritis, rheumatoid arthritis, endometriosis and fibromyalgia
Colds and flu
Headaches and migraines
Stomach and muscle cramps
Toothache
Trauma
When a tissue becomes damaged, pain receptors in the skin (also called nociceptors) are activated. This sends a signal from the peripheral nerve to the spinal cord which activates the release of neurotransmitters (chemical messengers).
A chain reaction of messages is then passed on to the brain that signals the parts of the brain that are responsible for physical sensation (the somatosensory cortex), thinking (frontal cortex) and emotions (limbic system). This results in someone feeling a pain sensation and reacting emotionally, either by crying or feeling irritated.
Types of pain
There are five different types of pain:
Acute pain is short-term pain that results from an injury or illness that usually lasts anywhere between a few minutes to three months. Once the injury or illness has resolved, the pain subsides.
Chronic pain is ongoing pain that doesn’t subside and continues for months or years. It can be a constant pain or intermittent, and is usually associated with chronic health conditions like arthritis and fibromyalgia or emotional issues.
Nociceptive pain presents as a sharp, throbbing, achy pain that is caused by external tissue damage such as scraping your knee or banging your arm. Nociceptive pain can be ether acute or chronic, affecting the skin, bones, tendons, muscles and joints.
Neuropathic pain feels like a shooting, stabbing or burning pain and is associated with nerve damage. It is type of chronic pain that can lead to mobility issues and affect touch sensitivity.
Radicular pain is pain that radiates from the back and hip through the spine and occurs when the spinal nerve becomes inflamed or compressed. It feels like a tingling pain and one may also experience numbness and muscle weakness. Sciatica is a type of radicular pain.
Chronic pain statistics (US)
According to the National Center of Health Statistics (CDC), 20.4% (50 million) of adults in the US suffer with chronic pain. The highest prevalence is among women (21.7%), non-Hispanic white adults (23.6%) and those aged 65 plus (30.6%). The pain is noticeable and experienced every day or most days.
Chronic pain appears to increase with age, affecting older adults more.
18 – 29 years: 25.8%
30 – 44 years: 14.6%
45 – 64: 25.8%
65 and over: 30.8%
7.4% of adults with chronic pain experience limited life or work activities due to their pain.
The most common types of pain are back pain, neck pain and tension-type headaches.
The risk factors for chronic pain include biological (genetics), socio-demographic, psychological and clinical factors. A person’s genes shape how they experience chronic pain and influences how they physically and emotionally react to pain. Genetics also affect pain sensitivity and pain tolerance levels.
Socio-economic background significantly affects prevalence of chronic pain and those with low levels of education, perceived income inequalities, and high levels of neighborhood deprivation are more likely to experience chronic pain.
Smokers and those who drink excessive alcohol report higher pain intensity and pain sensitivity scores.
Lack of sunshine and low vitamin D are linked to chronic pain; one study demonstrated that patients experienced less pain on sunny days. Vitamin D deficiency can cause changes in the body (anatomic, endocrine, immunological, neurological) that can trigger and perpetuate chronic pain.
Mental and emotional health are also linked to chronic pain and those with depression, anxiety and negative beliefs about pain are more likely to have prolonged chronic pain and a poorer recovery prognosis. One study demonstrated that patients with depression showed abnormal prefrontal brain activity and dysfunctional emotional regulation when exposed to experimentally induced painful stimuli in neuroimaging studies.
Socio-economic impact of chronic pain
Chronic pain poses a major clinical, social and economic problem, costing the US an estimated $635 billion per year. This figure comprises of healthcare costs, medical expenses, lost productivity (due to sick leave), lost income, disability benefits, worker compensation payments and legal charges. Chronic pain is considered more costly than cancer treatments and heart disease.
Chronic pain also reduces quality of life, often rendering some patients incapacitated or with reduced mobility. Pain can dramatically affect wellbeing, causing mental health issues, lowered mood, fatigue, sleep disturbances, the ability to exercise and social interactions with others.
Medication for pain management
In conventional medicine, chronic pain is usually managed with prescription drugs and over-the-counter medicine to provide pain relief for the patient. For mild or acute pain, one might use an over-the-counter painkiller like paracetamol (Tylenol, Panadol) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, Ibuprofen (Advil, Motrin, Nuprin) or naproxen (Aleve, Anaprox).
For severe or chronic pain, where patients seek advice from their physicians, the type of medication prescribed depends on the severity of pain and any other accompanying symptoms such as depression, anxiety or insomnia. There are often multiple components of the patient’s pain experience which will involve an interdisciplinary model of care approach involving medication, nerve blocks, physical therapy and behavioural interventions.
Prescription drugs for chronic pain management include:
Prescription NSAIDSs (Celebrex, Nalfon, Indocin) are a stronger dose than over-the-counter NSAIDs. They work by reducing inflammation and pain by blocking an enzyme called cyclooxygenase (COX) which is used by the body to make prostaglandins (a group of hormones that cause pain, inflammation and fever in response to tissue damage).
Strong painkillers like codeine or a transdermal Fentanyl patch (that is put on the skin). These are opioid analgesics that work on a pathway in the brain that changes how the body responds to pain.
Oxycodone is an opiate painkiller that works in a similar way to endorphins (natural analgesics) in the brain. Oxycodone reduces the pain messages sent from the body to the brain thus decreasing the overall pain felt by the person taking the medication.
Acetaminophen is both a pain reliever (analgesic) and fever reducer (antipyretic) and works by cooling the body down and changing how it responds to pain.
Muscle relaxants are often prescribed to reduce pain in combination with another type of pain killer or NSAID. They relax muscles to improve movement and range of motion, and reduce cramps and muscle spasms, which often alleviates pain.
Anti-anxiety drugs (Diazepam/ Valium) may be used to relieve pain associated with muscle spasm and neuropathic pain.
Anti-depressants (mainly Tricyclic anti-depressants such as Vivactil, Silenor and Norpramin) are often prescribed for chronic pain, even when depression isn’t a factor. They are commonly used for conditions like arthritis, nerve damage, headaches, migraines, back pain and fibromyalgia. It is thought that antidepressants reduce pain by increasing neurotransmitters in the spinal cord to reduce pain signals.
Steroid injections (hydrocortisone, triamcinolone, methylprednisolone) are injected straight into painful, swollen joints (shoulder, knee, hip, elbow, wrist, hand), tissues or muscles. Steroid injections work quickly, often relieving pain within a few hours, and lasting around six weeks to several months, dependent on the type of steroid administered.
Acupuncture for pain management
Acupuncture is a branch of Traditional Chinese Medicine that involves the use of small, thin needles which are inserted into specific acupuncture points on the body to elicit a response and bring the body back into balance. It is a highly effective and safe modality that can be used for a range of ailments and conditions.
Despite acupuncture not yet being thought of as a first line of therapy for pain management, Americans are becoming more aware of its benefits and open to trying acupuncture as a way to manage their pain. According to the National Health Interview Survey, an ongoing study that tracks healthcare habits in the US, 3.5 million Americans had tried acupuncture in 2012. This figure is likely to have significantly increased over the past nine years.
According to Grand View Research, the global complementary and alternative medicine market is expected to grow to over $210 billion by 2026. This demonstrates that the demand for alternative therapies like acupuncture is continuing to grow as people look for natural ways to address their ailments. Learn more about the statistics on complementary health and acupuncture.
For pain management, acupuncture works by:
Relieving pain and alleviating discomfort by relaxing muscles and stimulating the release of endorphins (natural pain-relieving chemicals) and serotonin (the happy hormone) to promote feelings of wellbeing. Learn more about acupuncture for pain.
Decreasing inflammation by increasing the production of cortisol, the hormone that helps control inflammation in the body. Learn more about acupuncture for inflammation.
Reducing muscle tightness and spasms. Overactive muscles and involuntary muscle contractions can cause pain; placing acupuncture points along trigger points helps release constricted muscles. Learn more about acupuncture for trigger points.
Promoting healthy blood circulation by modulating certain brain chemicals that constrict and dilate blood vessels. This is helpful for alleviating pain associated with migraines and headaches where vessel constriction (narrowing) and reduced blood flow is an issue.
Reducing stress and anxiety by regulating the hormones involved in the stress response (cortisol, serotonin, noradrenaline, dopamine). Acupuncture can help the body adapt to stress and initiate the relaxation response. Learn more about acupuncture for anxiety and acupuncture for stress.
Relaxing the nervous system by activating the rest and digest response (the opposite to the fight or flight response) which affects how the brain sends pain signals to the body. An overwhelmed or stressed nervous system will respond to pain more intensely and lower your threshold for pain. Learn more about acupuncture and the nervous system.
Aids tissue healing and repair by stimulating the release of fibroblasts; these are thecells found in connective tissue that secrete collagen proteins to maintain tissue health.
Learn more about:
Is acupuncture better than medication for chronic pain?
Research suggests that patients are often dissatisfied with conventional medical approaches and the need to take medication long-term to manage their pain, so they turn to complementary medicine to manage their pain in a more natural way.
Pain medication, especially opioids, can be addictive and cause unwelcome side effects such as drowsiness, nausea, vomiting, bowel disturbances, skin rashes, anxiety, irritability and brain fog.
Pain medication also doesn’t address the underlying causes of pain; it works as a band-aid, quietening the body’s pain signalling mechanism to relieve the pain, instead of getting to the root cause and resolving the issues causing the pain.
The US states of Ohio, Oregon and Rhode Island have extended Medicaid coverage for acupuncture (for pain relief) in a bid to cut opioid prescriptions.
In 2016, Vermont commissioned a study to assess acupuncture for patients with chronic pain in response to their opioid crisis. 156 Medicaid patients were offered 12 acupuncture treatments within a 60-day period. After receiving the course of acupuncture treatments, 57% of patient using analgesic (non-opioid) medications reported a reduction in use; 32% of patients using opioid medication reported a reduction in use; 72% reported an improved capacity to work and 96% of patients said they would recommend acupuncture for chronic pain as it improves physical, functional/ behavioral and psycho-emotional symptoms.
The US Department of Veterans Affair has trained more 2800 providers in “battlefield acupuncture” as a means to introduce non-pharmacological interventions after seeing the positive effects of acupuncture on combat veterans. In a sample of 2597 combat veterans, 44% of them reported having chronic pain. This particular type of acupuncture involves the insertion of acupuncture needles in the ear and has shown to be effective at relieving headaches, acute and chronic back and musculoskeletal pain and neuropathic pain.
In a meta-analysis, comparing acupuncture with other physical treatments for pain caused by osteoarthritis of the knee, acupuncture was considered one of the more effective treatments for alleviating pain.
One study looked at acupuncture versus medication for pain management in breast cancer survivors. Out of 592 participants, 27% preferred acupuncture, 25.8% preferred medication and 47.1% had no clear preference. The study demonstrated that acupuncture has an important role as an integrative (and patient-centred) approach for pain management and that patients should be given acupuncture as a choice for pain management.
Manage pain naturally with acupuncture
Chronic pain is complex condition that often reduces a patient’s quality of life and affects their wellbeing. The socio-economic cost of chronic pain is significant, making it one of leading health challenges of this century. Prescription drugs and over-the-counter pain medication are the first point of call for those experiencing chronic pain; however, many patients do not want to stay on medication forever and are looking for natural alternatives. Acupuncture has proved a safe and effective modality for pain management that works by reducing inflammation, aiding tissue repair and alleviating muscle spasms. Its effectiveness has been noted in numerous studies and many US states are promoting acupuncture as an alternative to opioid medication.
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