Acupuncture for pain relief

A patient on medications for several years can bring a change in life by adopting alternative therapies of pain management. A 65-year old army officer was on the Talwin (pentazocine) for several years. He used to self-administer the injection intramuscularly six times a day for pain management. While admitted to a psychiatric ward with chronic abdominal pain and symptoms of social withdrawal, a therapy of self-control of pain was started. The regimen consists of several sessions on the control of pain through relaxation, covert imagery, and cognitive reframing. Subsequently, he switched to diluted proportions of Talwin by increasing portions of normal saline. The army officer within a short span started to be more socially active without medication and could able to self-control pain.1 

Complimentary or Alternative Medication (CAM) is the approach towards treatments that are not part of the conventional medical system. The alternative methods of pain management during labor pain are discussed below: 

Acupuncture for Pain: Acupuncture is Chinese traditional therapy which is based on the balancing of Yin and Yang. The treatment focus on the normalization of the movements between the two opposites. Meridians are used as the energy channels to deliver medicines. The majority of the obstetrical and gynecological problems use spleen-pancreas (located on inside ankle bone) as a meridian. 

Several hypotheses stating the mechanism behind the therapy lead to the use of heat, pressure, the impulse of magnetic energy, burning by an herb of Artemia Vulgaris, electric stimulation by placing surface electrodes at various acupoints exceeding the manual use of needles in the procedure. One such possible theory is the stimulation of electrical properties at acupoints alters the level of chemical neurotransmitters in the body. Another new and more acceptable mechanism is the regulation of the release of endorphins from the hypothalamus. The effects of acupuncture are also attributed to the change in natural electrical currents or electromagnetic fields of the body.

Acupressure systems: As the name suggests, the therapy defines the application of pressure at points using hand, thumb, or fingers. The system offers a better circulation of blood, harmony of yin and yang through secretions of chemical neurotransmitters, and hence, promotes regular movements of the body. The local pressure is applied on both sides of the spine at the lower back to reduce the severity and frequency of labor pain.2 

Concern About Medication and Medication Use In Chronic Pain: Data from studies reveal patients suffering from chronic pain either take more or generally fewer medications as compared to their prescribed schedule. The belief or the concern of patients towards medicine decides their nonadherence towards the prescribed dosages. 

Opioids, most frequently used in chronic nonmalignant pain, patients reported the fear of addiction, undesirable side effects, and difficulties in obtaining refills from pharmacists despite the satisfying therapeutic benefits of the medications. The results conveyed by several studies regarding the concern of patients about the use of drugs in chronic pain can be summarized as below: 

● Non-adherence to the prescribed drugs can be due to the mistrust in the doctor and fear of addiction 

● Underuse of the chronic pain medications can be attributed to the concern of attached adverse effects, less perceived need or care about withdrawal 

● Overuse of the medicines can be due to the matter related to the negative scrutiny 

● Depression arises when tolerance develops with the use of drugs 

● Disability predicted by side effects and over tolerance3 

Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture and Spinal Manipulation Objective: To compare the efficacy of medication, acupuncture and spinal manipulation in the control of chronic spinal pain (>13 weeks) 

Study design: A randomized controlled trial (RCT) 

Assignment: Every patient was told to collect a slip from the box containing 150 slips of all three treatment options: medication, acupuncture, and spinal manipulation. The RCT did not include any untreated group, and hence, every group of treatment acted as a control group to others. 

Intervention Regimens:The clinicians examined patients prescribed randomly to the acupuncture or spinal manipulation before the start of the therapy. The clinical physician determined using the near and far technique which form of acupuncture to be used in which patients or what type of spinal manipulation would be performed on them to mobilize the joints. Moreover, the 20 minutes treatment time was set as the criteria for all the patients to remove the placebo effects of long exposures to the physicians. 

For medication therapy, the physician set the criteria of using those drugs which have not been consumed by the patients earlier. Celebrex (200-400 mg/day) used as the drug of choice to make the treatment generalized. The next option used was Vioxx (12.5-25 mg/day), followed by paracetamol (up to 4 g/day). 

Methods: The instruments used to determine the pain intensity and ranges of movement at the beginning, 2, 5 and 9 weeks of the therapies were Oswestry Back Pain Disability Index (Oswestry), Neck Disability Index (NDI), the Short-Form-36 Health Survey questionnaire (SF-36), and visual analog scales (VAS). 

Results: The RCT proved successful and gave the highest proportion of early recovery from spinal manipulation (27.3%), then acupuncture (9.4%), and lastly, medication (5%). VAS was the only scale where acupuncture proved better than the manipulation. Hence, spinal 

manipulations and acupuncture, if not contraindicated, can result in shorter greater-term improvement.4 

The raised concern for medications in the management of chronic pain due to the mistrust in the doctor, unwanted side effects, fear of addiction, withdrawal, and tolerance has let patients switched to alternative forms of treatment. Self-control pain through relaxation is the best among all, but generally, the unbearable pain subsides with this therapy. Amongst the remaining options, spinal manipulation, acupuncture, and acupressure are at the top of the list. Acupuncture for pain management is gaining worldwide importance due to the minimal side effects, and prolonged exposure to the physicians increases the placebo effects in the patients. Acupuncture treatment is a natural pain medication that has given promising results of improvement at every stage of the pain.