ACUPUNCTURE & PAIN

As discussed in previous updates, Traditional Chinese Medicine believes that a life-force energy permeates our bodies through meridians punctuated by acupuncture points. As a visualization, view the meridians as a pipeline through which life-force energy flows and the points as periodically placed, flow-controlling valves. With this analogy, acupuncture needles represent the socket wrenches that open the valves, promoting health-enhancing energy flow.

Evidence indicates that acupuncture may actually restore some function after SCI, perhaps, as studies suggest, by stimulating the expression of regenerative stem cells. Furthermore, acupuncture influences pain-processing neural pathways and neurotransmitter systems, which, in turn, affects the release of pain-reducing molecules and hormones. It has been extensively used by the general population to treat pain and may also reduce SCI-associated pain.

Studies

In 2001, Dr. Sangeetha Nayak’s team (New Jersey) treated 22 individuals with SCI and pain with 15 acupuncture sessions over a 7½-week period. In each session, 6 to 14 acupuncture points were needled, including a key point located in the Governor meridian between the C-7 and T-1 vertebrae.  

Subjects rated their pain intensity using a 0 (no pain) to10 (worst possible) pain scale. Using this scale, average pain decreased from 6.9 before to 5.4 after treatment, a reduction which persisted for some time. The more responsive subjects tended to have pain located above the injury, incomplete injuries, or musculoskeletal pain.

Reported in 2003, Dr. Linda Rapson and colleagues (Canada) used electro-acupuncture to treat SCI-associated neuropathic pain. Specifically, electrically stimulated acupuncture needles were inserted in three points further up the Governor meridian on the scalp midline and a fourth point located between the eyebrows. Patients were initially treated five times per week, and treatment was continued until full pain relief was obtained or no further benefits accrued. The investigators retrospectively reviewed the medical charts of 36 patients with spinal cord dysfunction (22 with traumatic injuries) and pain treated with electro-acupuncture over a five-year period.  Of these patients, 24 benefited from treatment, including 18 who experienced pain relief after only one treatment.

In 2001, Dr. Trevor Dyson-Hudson and colleagues (USA) evaluated the use of either acupuncture or bodywork to treat shoulder pain in manual wheelchair users. Subjects received either 10 acupuncture or bodywork sessions over five weeks. In each acupuncture session, various points associated with upper extremity pain and areas of tenderness were needled. In the bodywork sessions, gentle motions were used to loosen joints, ease movement, and release chronic-pain patterns.

Pain was assessed using the “The Wheelchair User’s Shoulder Pain Index” (WUSPI) in which subjects rated shoulder pain for 15 activities of daily living (e.g., transfers) using a 0 (no pain) to 10 pain (worst possible) scale for each activity. The scores for all activities were combined into a single 0-150 score. By the end of the treatment period, pain levels had decreased ~54% for both the acupuncture- and bodywork-treated individuals.

Because this study did not have a placebo-control group, the investigators initiated a somewhat similar investigation in 17 subjects with shoulder pain randomized to receive either 10 sessions of active or sham acupuncture. With the latter, putatively inactive areas near the true acupuncture points are needled. 

Using the WUSPI, shoulder pain in acupuncture-treated subjects decreased 66% compared to 43% for the sham-treated individuals. Seventy-five percent of the acupuncture-treated individuals reported a clinically meaningful reduction in pain after five weeks of treatment compared with only 25% for the sham-treated individuals. The investigators noted that the use of sham acupuncture points is problematic because they are not neutral controls.  Although not as effective as true acupuncture points, sham points also evoke physiological responses through different mechanisms.

In 2011, Drs. Cecilia Norrbrink et al (Sweden) treated 30 individuals with SCI and neuropathic pain for six weeks with either twice-weekly acupuncture or massage therapy. In each acupuncture session, 13-15 acupuncture points were needled, including several points stimulated by electro-acupuncture. The investigators used a 0 (no pain) to100 (most intense) scale to assess “general pain” and “pain unpleasantness” experienced during the last week, as well as “present pain.”  Specifically, general pain decreased from 63 to 48 after treatment, pain unpleasantness decreased from 70 to 47, and present pain decreased from 59 to 40. Smaller declines were observed for the massage group.

Conclusion

Many pharmaceutical or surgical approaches used to treat SCI-associated pain have serious, health-compromising side effects and are only marginally effective over the long term. Although not a panacea for pain, acupuncture is a side-effect-free, nothing-to-lose approach that may reduce quality-of-life-compromising pain.

Adapted from article appearing in February 2013 Paraplegia News (For subscriptions, call 602-224-0500) or go to www.pn-magazine.com. 

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