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The effectiveness of acupuncture analgesia has already been established in controlled clinical studies. As mentioned previously, acupuncture analgesia works better than a placebo for most kinds of pain, and its effective rate in the treatment of chronic pain is comparable with that of morphine. In addition, numerous laboratory studies have provided further evidence of the efficacy of acupuncture's analgesic action as well as an explanation of the mechanism involved. In fact, the excellent analgesic effects of acupuncture have stimulated research on pain.

Because of the side-effects of long-term drug therapy for pain and the risks of dependence, acupuncture analgesia can be regarded as the method of choice for treating many chronically painful conditions.

The analgesic effect of acupuncture has also been reported for the relief of eye pain due to subconjunctival injection (14), local pain after extubation in children (15), and pain in thromboangiitis obliterans (16).



Locomotor system
Chronically painful conditions of the locomotor system accompanied by restricted movements of the joints are often treated with acupuncture if surgical intervention is not necessary. Acupuncture not only alleviates pain, it also reduces muscle spasm, thereby increasing mobility. Joint damage often results from muscle malfunction, and many patients complain of arthralgia before any changes are demonstrable by X-ray. In these cases, acupuncture may bring about a permanent cure. Controlled studies on common diseases and conditions in this category have been reported by different authors, with favourable results for acupuncture treatments compared with standard therapy, delayed-treatment controls, control needling, mock TENS, or other sham acupuncture techniques. The conditions concerned include cervical spondylitis or neck pain due to other causes (33-37), periarthritis of the shoulder (38-39) fibromyalgia (40), fasciitis (41), epicondylitis (tennis elbow) (42-44), low back pain (45-49), sciatica (50-53), osteoarthritis with knee pain (54-56), and radicular and pseudoradicular pain syndromes (57). In some reports, comparison was made between standard care and acupuncture as an adjunct to standard care. The conclusion from one such randomized controlled trial was that acupuncture is an effective and judicious adjunct to conventional care for patients with osteoarthritis of the knee (58).

Rheumatoid arthritis is a systemic disease with extra-articular manifestations in most patients. In this disease, dysfunction of the immune system plays a major role, which explains the extra-articular and articular features. Acupuncture is beneficial in the treatment of rheumatoid arthritis (4-6). While acupuncture may not improve the damage that has been done to the joints, successful pain relief has been verified in the majority of controlled studies (58). The action of acupuncture on inflammation and the dysfunctional immune system is also beneficial (5, 59).

Gout
In a randomized controlled trial, blood-pricking acupuncture was compared with conventional medication (allopurinol). The acupuncture group showed greater improvement than the allopurinol group. In addition, a similar reduction of uric acid levels in the blood and urine of both groups was noted (60). Plum-blossom needling (acupuncture using plum-blossom needles), together with cupping (the application to the skin of cups which are then depressurized), has been recommended for treating gouty arthritis (61).

Biliary and renal colic
Acupuncture is suitable for treating acute pain, provided the relief of pain will not mask the correct diagnosis, for which other treatments may be needed. Biliary and renal colic are two conditions for which acupuncture can be used not only as an analgesic but also as an antispasmodic. In controlled studies on biliary colic (62-64) and renal colic (7, 65-66), acupuncture appears to have advantages over conventional drug treatments (such as intramuscular injection of atropine, pethidine, anisodamine (a Chinese medicine structurally related to atropine, isolated from Anisodus tanguticus), bucinnazine (also known as bucinperazine) or a metamizole-camylofin combination). It provides a better analgesic effect in a shorter time, without side-effects. In addition, acupuncture is effective for relieving abdominal colic, whether it occurs in acute gastroenteritis or is due to gastrointestinal spasm (67).

Traumatic or postoperative pain
For traumas such as sprains, acupuncture is not only useful for relieving pain without the risk of drug dependence, but may also hasten recovery by improving local circulation (68-70). Acupuncture analgesia to relieve postoperative pain is well recognized and has been confirmed in controlled studies (71-76). The first successful operation under acupuncture analgesia was a tonsillectomy. This was, in fact, inspired by the success of acupuncture in relieving post-tonsillectomy pain. Post-tonsillectomy acupuncture was re-evaluated in a controlled study in 1990, which not only showed prompt alleviation of throat pain, but also reduction in salivation and promotion of healing in the operative wound (76).


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