[tc-my-thumb]
One of the more difficult to treat conditions for me is one where a patient has been on Percocet, Codeine, Fentanyl for chronic pain. It is my experience that the long term use of these opioids alter the pain response in such a way that it is difficult to get long lasting improvement when they try to wean off the medication. (There is research to back up this notion).
Short term use these opioid class of drugs are imperative in severe injury cases as they can prevent chronic pain pathways from setting up. But when short term use turns into long term as is common with many pharmaceuticals then problems arise.
Surprisingly in response to the damaging side effects of opioids The American Academy of Neurology (AAN) just came out with a position paper on the use of these drugs:
“…Over 100,000 persons have died, directly or indirectly, from prescribed opioids in the United States since policies changed in the late 1990s…these deaths have exceeded mortality from both firearms and motor vehicle accidents….there is no substantial evidence for maintenance of pain relief or improved function over long periods of time without incurring serious risk of overdose, dependence, or addiction….”
Pretty incredible statement isn’t it? Over 100,000 people died directly from these drugs and there is no evidence of benefit for long term use in cases of mild to moderate pain, yet they have been prescribed for almost 15 years. The position of the AAN is to stop the widespread non-discriminate use of opioids especially in chronic cases. Of course this has made headlines as well as generated an interesting historical perspective on opioids at Time magazine that is definitely worth a read.
Ten Acupuncture Research Articles
Instead of taking drugs, turning to acupuncture is a great option for pain management. Many insurance companies now cover acupuncture for certain pain conditions. Not only does one get a reduction of pain, but also the additional wanted beneficial ‘side effects’ such as being more relaxed and improving the feel-good hormones.
Here are just a few studies that demonstrated the benefit of acupuncture over pharmaceuticals for pain management:
- During childbirth the use of acupuncture reduced the need of pharmaceuticals and invasive therapies. In additions Apgar scores at 5 minutes after birth were significantly better in the acupuncture group.
- Acupuncture and electro-acupuncture delayed the time of requesting morphine after cesarean section and decrease the morphine doses used within the first 24 hours.
- Acupuncture was just as effective as morphine for control of pain after nasal surgery. In addition the acupuncture had less post-op nausea and vomiting than the morphine group.
- Acupuncture with electrical stimulation improves acute postoperative pain management without adversely affecting vital signs after surgery for nontraumatic spinal injury.
- Auricular acupuncture reduced fentanyl requirement compared to sham procedure during hip arthroplasty.
- Electroacupuncture activates opioid receptors in the brain to inhibit pain sensitivity.
- Acupuncture as effective as an opioid for pain induced by a tourniquet.
- Acupuncture is an effective therapy for cancer pain.
- Acupuncture after inguinal surgery, can reduce the need of analgesics, which also directly reduces the complications that may occur when analgesics are used in relieving pain postoperatively.
- Acupuncture decreases perceived pain in children and adolescents after tonsillectomy and reduces opioid need.
Besides acupuncture there are many non-pharmaceutical approaches to pain management such Massage, Rolfing, Shiatsu, Chiropractic, Mind/Body therapies, Osteopathy, Diet and Nutraceuticals, Herbal Medicine. None of these therapies will cause fatalities and the side-effects are beneficial. It is a shame that opioids were used for so long and the insurance companies choose to decide to cover a pharmaceutical rather than many of the aforementioned therapies for pain management.
Got pain? Think Acupuncture.
References
Franklin GM. Opioids for chronic noncancer pain: A position paper of the American Academy of Neurology. Neurology. 2014 Sep 30;83(14):1277-84. PMID: 25267983. [PubMed] [Read by QxMD]
The Patient Safety Subcommittee requested a review of the science and policy issues regarding the rapidly emerging public health epidemic of prescription opioid-related morbidity and mortality in the United States. Over 100,000 persons have died, directly or indirectly, from prescribed opioids in the United States since policies changed in the late 1990s. In the highest-risk group (age 35-54 years), these deaths have exceeded mortality from both […]
Borup L1, Wurlitzer W, Hedegaard M, Kesmodel US, Hvidman L. Acupuncture as pain relief during delivery: a randomized controlled trial. Birth. 2009 Mar;36(1):5-12. PMID: 19278378. [PubMed] [Read by QxMD]
Many women need some kind of analgesic treatment to relieve pain during childbirth. The objective of our study was to compare the effect of acupuncture with transcutaneous electric nerve stimulation (TENS) and traditional analgesics for pain relief and relaxation during delivery with respect to pain intensity, birth experience, and obstetric outcome. […]
Wu HC1, Liu YC, Ou KL, Chang YH, Hsieh CL, Tsai AH, Tsai HT, Chiu TH, Hung CJ, Lee CC, Lin JG. Effects of acupuncture on post-cesarean section pain. Chin Med J (Engl). 2009 Aug 5;122(15):1743-8. PMID: 19781318. [PubMed] [Read by QxMD]
Post-operation pain is a very subjective phenomenon. The aim of this study was to find out the effects of acupuncture or electro-acupuncture on post-cesarean pain. […]
Sahmeddini MA1, Farbood A, Ghafaripuor S. Electro-acupuncture for pain relief after nasal septoplasty: a randomized controlled study. J Altern Complement Med. 2010 Jan;16(1):53-7. PMID: 20001536. [PubMed] [Read by QxMD]
Electro-acupuncture (EA) can be effective in some pain conditions, but still there have been no randomized controlled studies of EA for treatment of acute postoperative pain in nasal septoplasty. Therefore, we did a study to test whether EA of specific points is superior to sham acupuncture for complementary analgesia after nasal septoplasty. […]
Harris RE1, Zubieta JK, Scott DJ, Napadow V, Gracely RH, Clauw DJ. Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs). Neuroimage. 2009 Sep;47(3):1077-85. PMID: 19501658. [PubMed] [Read by QxMD]
Controversy remains regarding the mechanisms of acupuncture analgesia. A prevailing theory, largely unproven in humans, is that it involves the activation of endogenous opioid antinociceptive systems and mu-opioid receptors (MORs). This is also a neurotransmitter system that mediates the effects of placebo-induced analgesia. This overlap in potential mechanisms may explain the lack of differentiation between traditional acupuncture and either non […]
Hu L1, Chu NN, Sun LL, Zhang R, Han JS, Cui CL. Electroacupuncture treatment reverses morphine-induced physiological changes in dopaminergic neurons within the ventral tegmental area. Addict Biol. 2009 Sep;14(4):431-7. PMID: 19489751. [PubMed] [Read by QxMD]
Chronic morphine administration decreases the size of dopamine (DA) neurons in the ventral tegmental area (VTA). These transient morphological changes are accompanied by a reduced sensitivity of morphine-induced conditioned place preference (CPP) after chronic exposure to the drug. In this study we examined alterations in the firing rate of DAergic neurons by means of extracellular recording following chronic morphine exposure and applied 100 Hz […]
Léonard G1, Cloutier C, Marchand S. Reduced analgesic effect of acupuncture-like TENS but not conventional TENS in opioid-treated patients. J Pain. 2011 Feb;12(2):213-21. PMID: 20870464. [PubMed] [Read by QxMD]
Evidence from recent animal studies indicates that the analgesic effect of low-frequency transcutaneous electrical nerve stimulation (TENS) is reduced in opioid-tolerant animals. The aim of the present study was to compare the analgesic effect of conventional (high frequency) and acupuncture-like (low frequency) TENS between a group of opioid-treated patients and a group of opioid-naive patients in order to determine if this cross-tolerance effec […]
Usichenko TI1, Dinse M, Lysenyuk VP, Wendt M, Pavlovic D, Lehmann C. Auricular acupuncture reduces intraoperative fentanyl requirement during hip arthroplasty–a randomized double-blinded study. Acupunct Electrother Res. 2006;31(3-4):213-21. PMID: 17608061. [PubMed] [Read by QxMD]
We studied whether auricular acupuncture reduces analgesic requirement during total hip arthroplasty. Sixty-four patients were enrolled in this patient/anesthesiologist-blinded study according to inclusion criteria. They were randomly assigned to receive acupuncture with indwelling fixed needles (points lung, shenmen, forehead and hip) or sham procedure (4 non-acupuncture points on the helix). Surgery was performed under standardized general anes […]
Wetzel B1, Pavlovic D, Kuse R, Gibb A, Merk H, Lehmann C, Wendt M, Usichenko TI. The effect of auricular acupuncture on fentanyl requirement during hip arthroplasty: a randomized controlled trial. Clin J Pain. 2011 Mar-Apr;27(3):262-7. PMID: 21346689. [PubMed] [Read by QxMD]
Although auricular acupuncture (AA) is suggested to be effective in treatment of pain, it has not yet been used for intraoperative analgesia. Therefore, we studied whether the AA reduces intraoperative analgesic requirement during total hip arthroplasty (THA). […]
Stone JA1, Johnstone PA. Mechanisms of action for acupuncture in the oncology setting. Curr Treat Options Oncol. 2010 Dec;11(3-4):118-27. PMID: 21108052. [PubMed] [Read by QxMD]
A growing body of literature supports the use of acupuncture in the oncology clinic for the relief of symptoms caused by cancer treatments. Several clinical trials are currently supported by the National Institutes of Health to assess the efficacy of such treatments, as evidenced by the listings in the National Institutes of Health Computer Retrieval of Information on Scientific Projects (CRISP) database. However, little is known about the mechan […]
Ursini T1, Tontodonati M, Manzoli L, Polilli E, Rebuzzi C, Congedo G, Di Profio S, Toro PM, Consorte A, Placido G, Laganà S, D’Amario C, Granchelli C, Parruti G, Pippa L; VZV Pain Study Group. Acupuncture for the treatment of severe acute pain in herpes zoster: results of a nested, open-label, randomized trial in the VZV Pain Study. BMC Complement Altern Med. 2011 Jun 5;11:46. PMID: 21639941. [PubMed] [Read by QxMD]
Data on the potential efficacy of acupuncture (AC) in controlling intense or very intense pain in patients with Herpes Zoster (HZ) has not been so far adequately assessed in comparison with standard pharmacological treatment (ST) by a controlled trial design. […]
Lu W1, Rosenthal DS. Acupuncture for cancer pain and related symptoms. Curr Pain Headache Rep. 2013 Mar;17(3):321. PMID: 23338773. [PubMed] [Read by QxMD]
Cancer pain is one of most prevalent symptoms in patients with cancer. Acupuncture and related techniques have been suggested for the management of cancer pain. The National Comprehensive Cancer Network guidelines for adult cancer pain recommends acupuncture, as one of several integrative interventions, in conjunction with pharmacologic intervention as needed. This review presents the latest available evidence regarding the use of acupuncture for […]
Musial F1, Choi KE, Gabriel T, Lüdtke R, Rampp T, Michalsen A, Dobos G. The effect of electroacupuncture and tramadol on experimental tourniquet pain. Acupunct Med. 2012 Mar;30(1):21-6. PMID: 22378583. [PubMed] [Read by QxMD]
The hypoalgesic effect of electroacupuncture (EA) was directly compared with the analgesic effect of pharmacological interventions using the submaximum effort tourniquet technique (SETT). […]
Groppetti D1, Pecile AM, Sacerdote P, Bronzo V, Ravasio G. Effectiveness of electroacupuncture analgesia compared with opioid administration in a dog model: a pilot study. Br J Anaesth. 2011 Oct;107(4):612-8. PMID: 21749999. [PubMed] [Read by QxMD]
Although opioid analgesics are the usual drugs to treat post-surgical pain, acupuncture has also been demonstrated to relieve various pain syndromes. The present pilot study aims to investigate the efficacy of electroacupuncture compared with a conventional opioid compound, butorphanol, for postoperative pain treatment in dogs undergoing elective ovariohysterectomy. […]
Zhou YY1, Wanner NJ, Xiao Y, Shi XZ, Jiang XH, Gu JG, Xu GY. Electroacupuncture alleviates stress-induced visceral hypersensitivity through an opioid system in rats. World J Gastroenterol. 2012 Dec 28;18(48):7201-11. PMID: 23326125. [PubMed] [Read by QxMD]
To investigate whether stress-induced visceral hypersensitivity could be alleviated by electroacupuncture (EA) and whether EA effect was mediated by endogenous opiates. […]
Ochi JW. Acupuncture instead of codeine for tonsillectomy pain in children. Int J Pediatr Otorhinolaryngol. 2013 Dec;77(12):2058-62. PMID: 24210291. [PubMed] [Read by QxMD]
Severe throat pain can result from tonsillectomy and last up to 10 days in children. Codeine elixir has long been used for pain relief, but has recently been banned by the Food and Drug Administration due to a recently recognized risk of death. We explored acupuncture as an alternative means of pain relief for children and adolescents after tonsillectomy. […]
Paley CA1, Bennett MI, Johnson MI. Acupuncture for cancer-induced bone pain? Evid Based Complement Alternat Med. 2011;2011:671043. PMID: 21799687. [PubMed] [Read by QxMD]
Bone pain is the most common type of pain in cancer. Bony metastases are common in advanced cancers, particularly in multiple myeloma, breast, prostate or lung cancer. Current pain-relieving strategies include the use of opioid-based analgesia, bisphosphonates and radiotherapy. Although patients experience some pain relief, these interventions may produce unacceptable side-effects which inevitably affect the quality of life. Acupuncture may repre […]
Meng X1, Zhang Y, Li A, Xin J, Lao L, Ren K, Berman BM, Tan M, Zhang RX. The effects of opioid receptor antagonists on electroacupuncture-produced anti-allodynia/hyperalgesia in rats with paclitaxel-evoked peripheral neuropathy. Brain Res. 2011 Sep 26;1414:58-65. PMID: 21872220. [PubMed] [Read by QxMD]
Research supports the effectiveness of acupuncture for conditions such as chronic low back and knee pain. In a five-patient pilot study the modality also improved the symptoms of chemotherapy-induced neuropathic pain. Using an established rat model of paclitaxel-induced peripheral neuropathy, we evaluated the effect of electroacupuncture (EA) on paclitaxel-induced hyperalgesia and allodynia that has not been studied in an animal model. We hypothe […]
Gakiya HH1, Silva DA, Gomes J, Stevanin H, Cassu RN. Electroacupuncture versus morphine for the postoperative control pain in dogs. Acta Cir Bras. 2011 Oct;26(5):346-51. PMID: 21952656. [PubMed] [Read by QxMD]
To compare the postoperative analgesic effects of electroacupuncture, morphine or sham acupuncture in dogs undergoing mastectomy. […]
Wang Y1, Hackel D, Peng F, Rittner HL. Long-term antinociception by electroacupuncture is mediated via peripheral opioid receptors in free-moving rats with inflammatory hyperalgesia. Eur J Pain. 2013 Nov;17(10):1447-57. PMID: 23649949. [PubMed] [Read by QxMD]
Electroacupuncture (EA) has been widely accepted and applied as an important acupuncture-related technique for acupuncture analgesia (AA) research. The involvement of opioid peptides and receptors in acute AA has been shown via pre-EA application of opioid receptor/peptide antagonists. In this study, we intended to reproducibly institute acupoint position and needling excluding influences from anaesthesia or restrainers on rats with complete Freu […]
Chao D1, Shen X, Xia Y. From Acupuncture to Interaction between δ-Opioid Receptors and Na (+) Channels: A Potential Pathway to Inhibit Epileptic Hyperexcitability. Evid Based Complement Alternat Med. 2013;2013:216016. PMID: 23662118. [PubMed] [Read by QxMD]
Epilepsy is one of the most common neurological disorders affecting about 1% of population. Although the precise mechanism of its pathophysiological changes in the brain is unknown, epilepsy has been recognized as a disorder of brain excitability characterized by recurrent unprovoked seizures that result from the abnormal, excessive, and synchronous activity of clusters of nerve cells in the brain. Currently available therapies, including medical […]
Mayor D. An exploratory review of the electroacupuncture literature: clinical applications and endorphin mechanisms. Acupunct Med. 2013 Dec;31(4):409-15. PMID: 23917395. [PubMed] [Read by QxMD]
Electroacupuncture (EA) is widely used in clinical practice and research, as well as in experimental investigations into the mechanisms of acupuncture. This study explores publication trends in clinical and experimental studies of EA (1975-2011) for pain and non-pain research; EA use for different clinical conditions (1974-2012); and the relation of EA research, including stimulation frequency, to opioid peptide mechanisms. Appropriate PubMed ‘al […]
Yeh ML1, Chung YC, Chen KM, Tsou MY, Chen HH. Acupoint electrical stimulation reduces acute postoperative pain in surgical patients with patient-controlled analgesia: a randomized controlled study. Altern Ther Health Med. 2010 Nov-Dec;16(6):10-8. PMID: 21280458. [PubMed] [Read by QxMD]
The purpose of this study was to evaluate the effect of acupoint electrical stimulation with patient-controlled analgesia (PCA) on reducing acute pain, nausea, and vomiting after surgery for nontraumatic spinal cord injury. […]