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by Corey

Review: “I Felt Like It Was God’s Hands Putting the Needles In”: A Qualitative Analysis of the Experience of Acupuncture for Chronic Pain in a Low-Income, Ethnically Diverse, and Medically Underserved Patient Population

This qualitative analysis published in 2015 (Kligler et al) was conducted to understand the experience of acupuncture treatment in specifically low-income, ethnically diverse, and medically underserved populations as part of the parent trial, ADDOPT (Acupuncture to Decrease Disparities in Outcomes of Pain Treatment). Probe questions were asked in phone interviews to 37 participants of ADDOPT, 6 to 18 months after the trial completed. Participants for this study were recruited from two equal-size lists, generated from patients who demonstrated a significant improvement in pain and another from those who did not. 8 initial interviews were conducted and subjected to a preliminary analysis, after which several questions were added for the remaining 29 interviews. An inductive thematic analysis demonstrated that three main themes of the acupuncture experience were mentioned during the interviews. The participants’ decision-making process to try acupuncture was one theme. Willingness to try something new, feeling that medications were not working, and a sense of desperation were cited as factors. The treatment process experience was another theme. Participants described different ways that acupuncture was different than their usual medical experience. Patients didn’t feel that they needed to know how acupuncture worked in order for it to be effective but many patients felt that being open to the power of the mind would produce positive results. The third theme was the impact of acupuncture on their health. Many reported the positive effects acupuncture had on stress, depression, anxiety, sleep, and gynecological issues. One limitation mentioned by the researchers was the delay in time before interviews could be started after trial due to the need to ensure with quantitative analysis that an adequate sampling of responders and non-responders in the parent trial were included. This could have led to biased perspectives from participants. Cost and access were cited for further review to address acupuncture’s potential use for care in this patient population.

 

Reference

Kligler B., Buonara M., Gabison J., Jacobs E., Karasz A., McKee M.D. (2015). “I Felt Like It Was God’s Hands Putting the Needles In”: A Qualitative Analysis of the Experience of Acupuncture for Chronic Pain in a Low-Income, Ethnically Diverse, and Medically Underserved Patient Population. The Journal of Alternative and Complementary Medicine, 2015, 21(11):713-9. http://doi.org/10.1089/acm.2014.0376

by Corey

Acupuncture for postoperative pain

Acupuncture can be helpful in postoperative care after back surgery or joint replacement, specifically for patients interested in or recommended for non-pharmacologic pain management.

Acute pain resulting from surgical trauma can present significant challenges by delaying the ability of patients to move about and begin to perform rehabilitation exercises that are important to help reduce the development of scar tissue, improve range of motion, and increase the chances for a successful recovery. In addition, patients who undergo spinal and joint replacement surgery are at greater risk for developing a deep vein thrombosis and their risk may increase if pain continues to limit physical movement after surgery.

While opioid medication are typically effective to reduce pain, they also can cause unwanted side effects like nausea, vomiting, dizziness, sedation, pruritus, constipation, and urinary retention. These can further delay recovery and lead to a decreased sense of satisfaction with the surgical procedure by the patient.

Acupuncture can offer an alternative to opioids and is commonly uses for pain management. It can provide a safe and effective non-pharmacologic option to manage acute postoperative pain. Several related systemic reviews of randomized controlled trials have been conducted on this subject and found acupuncture to be effective in reducing post-surgical pain intensity and lead to a lower incidence of opioid-related side effects when used alongside conventional interventions for pain. Citations for these reviews are included at the end of this article. One meta-analysis specifically summarizes the effectiveness of acupuncture treatment for pain reduction after back surgery.

Further studies have shown the pain modulating effects of acupuncture to be due to its ability to augment the peripheral and central nervous system to inhibit pain-signaling pathways and increase the threshold for pain tolerance. Acupuncture has been recognized to trigger the release of specific neuropeptides including beta-endorphins, enkephalins, and dynorphins to elicit a self-healing response and create analgesia.

When being used for surgical pain, acupuncture has been found to be especially helpful when received within 24 hours before surgery as well as within the first week after surgery. Additionally, acupuncture can address pain or debility that may occur during and after the rehabilitation phase and can be useful in a multi-modal approach for patients experiencing lowered signs of progress with standard care alone.

 

Acupuncture for Postoperative Pain Research Citations

Systemic Reviews and Meta-analyses

Liu X.L., Tan J.Y., Molassiotis A., Suen L.K., Shi Y. (2015). Acupuncture-point stimulation for postoperative
 pain control: A systematic review and meta-analysis of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine, 2015;2015:657809. http://doi.org/10.1155/2015/657809

Sun Y., Gan T.J., Dubose J.W., Habib A.S. (2008). Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials. British Journal of Anaesthesia, 101(2):151-160. http://doi.org/10.1093/bja/aen146

Wu M.S., Chen K.H., Chen I.F., Huang S.K., Tzeng P.C., Yeh M.L., Lee F.P., Lin J.G., Chen C. (2016). The efficacy of acupuncture in post-operative pain management: A systematic review and meta-analysis. PloS One, 11(3). http://doi.org/10.1371/journal.pone.0150367

 

Acupuncture Mechanism of Action Studies
Mayor D. (2013). An exploratory review of the electroacupuncture literature: clinical applications and endorphin mechanisms. Acupuncture in Medicine, 31(4):409-15. s

Wang J.Q., Mao L., Han J.S. (1992). Antinociceptive effects induced by electroacupuncture and transcutaneous electrical nerve stimulation in the rat. Int J Neurosci. 1992; 65: 117–129.

Zhao Z.Q. (2008). Neural mechanism underlying acupuncture analgesia. Progress in Neurobiology, Aug;85(4):355-75. http://doi.org/10.1016/j.pneurobio.2008.05.004

by Corey

Is acupuncture painful? The concept of deqi

There is a range of different styles that have been developed throughout the history of acupuncture that incorporate a variety of different needling techniques. While some, like seen in Japanese acupuncture, use a very superficial insertion of needles just under the skin with an extremely gentle stimulation of the point locations, it has become a commonly accepted practice in Traditional Chinese Medicine to elicit a strong needle sensation experienced by the patient at each point location by inserting a needle to the desired depth (based on anatomical location) and manipulating the needle manually by lifting and reinserting it or by twirling the needle.

This can be felt by patients in a various ways and described as a soreness, numbness, distension, heaviness, or pain. Yes, pain. Acupuncture has long been touted as not being painful but this is not always the case. This may be due to this technique being central to the clinical practice of acupuncture for over 2000 years that this strong needle sensation was recognized to have unique therapeutic value and experienced separate from pain. For many Americans, though, who are new to acupuncture, acupuncture can be described as being painful.

The needling sensation can also be observed by the practitioner as a gripping quality around the needle when tugged, an involuntary twitching of the muscles, and sometime redness of the skin around the needle site.

If you’ve read any research trials that utilize acupuncture treatment, you may have seen this technique described in the Methods section as “needling sensation, “acupuncture with stimulation,” or sometimes by the pinyin term “deqi” which is commonly translated as “obtaining the vital energy”. Interestingly, researchers have also studied this needling sensation with neuroimaging using fMRIs and have found stronger activation of different regions of the brain than when using only tactile superficial stimulation of acupuncture points.

In the scientific community, this local sensation felt by patients has long been associated with stimulation of afferent nerve fibers but more recent research suggests that involvement of the deformation of connective tissue through acupuncture may play a strong part with the mechanism of acupuncture. Local vasodilation also results from needle stimulation along with the local release of substances like histamine, nitric oxide, prostaglandins, and many others which are currently being studied for their relationship in explaining how acupuncture works.