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.
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]
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]
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]
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]
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]
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]
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]
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]
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]
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]
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]
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]
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]
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]
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]
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]
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]
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]
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]
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]
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]