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Acupuncture for Our Nation’s Pain and Opioid Epidemics- My Two Cents

According to recent estimates, as many as 100 million Americans suffer from some degree of pain on a regular basis. Chronic pain (pain persisting for > 3mo) is particularly disabling and is significantly associated with loss of productivity, substance abuse, and depression.

Conventional pain management strategies typically involve medications and/or invasive procedures, but “fixing” pain is seldom as simple as merely administering a pill, anesthetizing the source or replacing a defective body part. Pain often has its origins in maladaptive lifestyle habits (lack of exercise, too much exercise, poor diet and sleep habits, overwork, poor body mechanics, etc) and life stresses. Furthermore, chronic, persistent pain often relates to biomechanical stresses resulting from protective adaptations to discomfort and to inactivity (due to fears that exercise will make pain worse). Factors involved in the genesis and maintenance of pain must be addressed when possible.

While pharmacologic therapy can be appropriate for management of pain, it frequently is ineffective (particularly for chronic pain) and is often associated with troublesome medication side effects. Opioids, the traditional “go to” option when less potent analgesics have failed, may be useful for acute pain but the efficacy of opioids for treating chronic pain has not been established and chronic opioid use poses significant risk for addiction.

Unfortunately, opioid addiction is a very real problem in the United States today and sadly, legally prescribed narcotic pain relievers are all too often the gateway to addiction.

Cracking down on opioid abuse, restricting the prescribing of opioids, and making narcotic overdose antidotes more widely available (as the FDA and CDC have suggested) address the opioid problem but do nothing to solve our nation’s pain problem.

Interventions for pain, such as injections into spinal nerves, nerve deadening procedures, implantation of spinal cord stimulators, and major surgeries often provide only temporary relief of discomfort, may be ineffective and at worst, can sometimes exacerbate the very pain they are employed to treat. These procedures are also expensive and because they are “invasive”, confer risks of infection, organ damage and even death.

Clearly we need to partner with our patients in their own pain management and we need more effective, lower risk strategies for treating pain

And this is where I believe acupuncture can play a key and valuable role.

The benefits of acupuncture were first documented in the Western world in the early 1800s when European physicians learned of the technique and began experimenting with it and reporting successes in the treatment of pain. In 1826, Benjamin Franklin Bache, grandson of Benjamin Franklin, reported in the North American Medical Surgical Journal on 12 patients from the Philadelphia prison system whom he treated for various chronic pain conditions with “acupuncturation”. Bache’s technique involved inserting needles locally at sites of pain and thus was distinct from the meridian based traditional Chinese approach, but was acupuncture nevertheless (and incidentally more akin to my own approach). Case histories and treatment protocols were recorded meticulously and the majority of the patients had either complete or partial resolution of symptoms, with benefits maintained at 3 month follow up visits. But despite Bache’s work and numerous favorable reports in the medical literature between 1800 and 1840, acupuncture never garnered widespread attention and by the mid 1800’s, had almost completely faded from Western attention.

There were probably several reasons for this: First, the notion of inserting needles into the body to relieve pain was counterintuitive; second, the development of

laudanum and surgical anesthetics ushered in the era of modern pharmacology with the promise of pharmaceutical solutions for pain; third, the failure to advance a plausible scientific theory to explain acupuncture’s mechanisms of action hampered its acceptance in the medical community.

In many respects, the advancement of acupuncture is still hindered by the same obstacles.

Consider that a study published in the Archives of Internal Medicine in 2012 showed acupuncture to be effective for treatment of a variety of chronic pain conditions. Yet despite the findings of this study and a large body of additional supportive research, physicians seldom consider recommending acupuncture for pain and fewer than 10% of Americans have tried acupuncture.

Lack of coverage by insurance carriers is certainly a major factor in the underutilization of acupuncture but it is also human nature (exploited by the pharmaceutical and medical industries) to want quick fixes for our problems with a minimum of personal investment in the process. And pharmaceutical companies and purveyors of interventions often promise quick and easy results.

While no one knows precisely how or why acupuncture works, I believe strongly that its benefit derives from the fact that it marshals the body’s innate self-healing defenses.

And as a physician acupuncturist with a practice devoted to treatment of pain, I can testify that acupuncture works, often amazingly well, for a great many conditions including headaches, neck pain, lower back pain, shoulder pain, and tendonitis to name a few.

But in my experience, acupuncture achieves best results when utilized relatively early in the course of pain, in conjunction with appropriate lifestyle changes and a regime of regular exercise. And such an approach makes sense because it promotes self-management of pain as opposed to an approach where drugs are employed to mask pain or where the doctor plays the role of a mechanic whose job is to “fix” the patient.

At a cost of $75-100 per treatment, and with most insurance companies not covering the cost, many are put off by acupuncture’s price tag. But fewer sessions are needed when acupuncture is employed early in the cycle of pain and with such a strategy, most clients would actually SAVE time and money in the long run with considerably less suffering.

In summary, we have a chronic pain problem in the United States today and secondarily (from relying too heavily on narcotics for management of intractable pain), we (the medical and pharmaceutical industries) have helped to create an opioid crisis.

It is clear that we need to change our approach to managing pain. I do not believe the solutions lie in new and improved drugs or more complex medical interventions. Rather, we (the medical community) must advocate for our patients to become more invested in their own health by encouraging healthier lifestyles and promoting self-care. And when pain does occur, we must look for and address the root causes, and when possible, act to prevent the transition of acute pain to chronic pain. And if a little help is required in that effort, the low tech 2000 year old healing art of acupuncture may be the best tool in the toolbox.

Michael D. Martin, M.D.