Why acupuncture for chronic pain?

Angelica Fargas-Babjak, MD, FRCPC
Alejandro Elorriaga Claraco, MD (Spain)

Pain is the most common symptom that brings people to the doctor. Most of the time it is reversible conditions and it will get better. However, pain may persist after the original cause has disappeared, and chronic pain develops. Chronic pain is defined as pain that persists six months after an injury and beyond the usual recovery time of a comparable injury. This is a costly condition, in terms of human suffering, and in health care cost. For instance, according to recent statistics, 3.9 million adults in Canada (17% of the population) suffer from chronic pain.

Chronic pain is a multi-dimensional experience, consequently, multi-disciplinary pain management teams are needed to help these patients. Now-a-days a typical team may include, acupuncturists, chiropractors, nurses skilled in therapeutic touch, councillors and dieticians.

In 1984, at McMaster University Hospital, Dr. Angelica Fargas-Babjak pioneered the inclusion of acupuncture and nonpharmacological therapies for the treatment of patients with chronic pain.

At the McMaster Acupuncture/Pain Clinic each patient is interviewed and examined in depth before a treatment plan is discussed. Discussion includes the selection of realistic therapeutic goals and appropriate clinical outcome measures. Therapeutic interventions most commonly used include life-style adjustments, exercise, counseling regarding diet and pacing, acupuncture, breathing exercises and relaxation techniques. With this approach patients become more self-reliant, expanding their knowledge about their bodies, and developing new strategies to manage their pain. Acupuncture treatment is offered when deemed appropriate for a particular patient, and integrated along with the other treatment inputs. Patient’s preferences are always respected.

Acupuncture clinics require sufficient space and skilled personnel. Although the actual equipment is simple, treatments can be relatively expensive in terms of professional time due to the need for repeated visits required for the management of chronic conditions. Benefits, though, clearly offset costs and acupuncture is currently a treatment option in many pain management clinics.

Acupuncture is an elegant and gentle treatment approach that activates physiologic adaptive responses of the body. It is both a systemic and a local therapy, with a variety of biologic effects triggered by the insertion and manipulation of the acupuncture needles. Considerable evidence supports the claim that opioid peptides are released during acupuncture, explaining at least partially its analgesic effects. Acupuncture stimulation activates the hypothalamus and the pituitary gland, producing a broad spectrum of systemic effects including secretion of neurotransmitters and neurohormones both centrally and peripherally. There is also evidence of changes in immune function.

The addition of electrical stimulation to acupuncture enhances its analgesic effects. Research has shown two clearly defined acupuncture analgesia models. One is endorphin-dependent, involving low-frequency, high-intensity electrical stimulation. The response is slow in onset, generalized throughout the body, and cumulative on subsequent stimulation. The other system is monoamine-dependent and involves high-frequency, low-intensity electrical stimulation. This response is rapid in onset, distributed according to the segments of the spinal cord, and is not cumulative.

In an integrated health care model, medication, surgical procedures or other interventions should be integrated with therapies such as acupuncture which stimulate the natural homeostatic mechanisms of the body. We also need to provide humane caring treatment based on the best available evidence. There is still a lack of well designed studies of acupuncture but a number of different clinical trials are already under way. Meanwhile acupuncture is an effective and valuable approach when incorporated into a multi-modal integrated health care model.

More and more doctors and other health care providers are learning about acupuncture and are incorporating this safe and effective modality into their treatment plans. Rational use of acupuncture is cost-effective, helping to prevent some of the iatrogenic side effects of certain drugs and invasive procedures used in pain management. In the immediate future, we need to look into the use of acupuncture in the integral care of other patients, such as those suffering with cancer. Acupuncture can play a role in the control of nausea and vomiting, and in helping these patients to optimize their available regulatory mechanisms, for a higher quality of life.
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For the last three years, the McMaster University Continuing Education Department has been offering a comprehensive training program in acupuncture for health professionals, designed following the recommendations of the World Health Organization (WHO). This training focuses on the applications of acupuncture for the treatment of pain and common problems of disregulation such as fatigue, digestive problems, or menstrual disorders. This high quality program is only opened to licensed physicians, chiropractors, physiotherapists, and naturopaths. Clinical applications are studied using an integrated problem-based learning approach, where understanding of treatment principles is emphasized. So far the courses have been attended by a mixture of health care providers from both Canada and the United States. Course participants have expressed great satisfaction and enthusiasm for this integrated approach combining acupuncture with standard health care. Information is available at McMasterAcupuncture.com/ or by calling 905-521-2100 X75175.