A Brief Overview of Pain Relief and Acupuncture

Introduction

For those living with pain, it can be debilitating. It can interfere with your ability to sleep, work, and to enjoy life (SIGN, 2013). It can also aggravate other health conditions and lead to depression and anxiety symptoms. With this in mind, relieving pain requires a holistic approach that embraces the whole person, not just the source of pain (which cannot always be easily identified). Many people find it useful to choose from a menu of different pain relief (both treatments and remedies), combining them in a regimen that fits their lifestyles.

It is important to recognise when it is time to see a medical professional for an evaluation of pain. For example, new pain that is severe or does not seem to be getting better should prompt a call to your medical professional.

120216-N-PB383-414 ARABIAN GULF (Feb. 16, 2012) Cmdr. Yevsey Goldberg conducts an acupuncture procedure on a patient aboard the amphibious transport dock ship USS New Orleans (LPD 18). New Orleans and embarked Marines assigned to the 11th Marine Expeditionary Unit (11th MEU) are deployed as part of the Makin Island Amphibious Ready Group, supporting maritime security operations and theater security cooperation efforts in the U.S. 5th Fleet area of responsibility. (U.S. Navy photo by Mass Communication Specialist 2nd Class Dominique Pineiro/Released).

What are the Types of Pain?

There are different types of pain and you may experience more than one type, with the table below outlining the four most common types of pain (UHS, 2019).

Type of Pain	Outline
Acute Pain (Short-Term Pain)	Acute pain is a short-term pain that is caused by something specific, such as an operation, injury or illness. It can be severe, but it usually gets better quite quickly (within a few days or weeks).
Chronic Pain (Long-Term Pain)	Chronic pain, also known as persistent pain, is a long-term pain (usually more than 12 weeks (SIGN, 2013)) that causes a variety of symptoms including pain, immobility (difficulty moving), low mood and problems with sleeping. Unlike acute pain, chronic pain is often difficult to treat and most people will never be completely pain free.
Neuropathic Pain	Neuropathic pain is a type of chronic pain associated with damage to the nerves. Examples of neuropathic pain include sciatica, pain after an amputation, pain after a shingles infection and pain after spinal surgery.
Cancer Pain	Cancer pain is often a result of tissue damage. It can be caused by the cancer itself (the tumour) or cancer treatment, such as radiotherapy. Cancer pain can be severe and may require large amounts of pain relief medications.

What Types of Pain Relief are Available?

Pain relief can be achieved through a number of therapies, including (UHS, 2019):

Drug therapies, three common groups of pain relief medications include:
- Also known as standard approach.
- Paracetamol.
- Anti-inflammatory, such as ibuprofen, diclofenac, and naproxen.
- Opioids, such as codeine, dihydrocodeine, tramadol, morphine, and oxycodone.
Non-drug therapies:
- Also known as alternative pain-relief approach.
- Range from acupuncture and mind-body therapies to spinal manipulation, physical and occupational therapies, herbal remedies, mindfulness meditation, and music therapy among others.
Surgical repairs of specific problems.

What is Acupuncture and How Does it Work?

Acupuncture is a treatment derived from ancient Chinese medicine, in which fine needles are inserted at certain sites in the body for therapeutic or preventative purposes (NHS, 2019). This stimulates sensory nerves under the skin and in the muscles, resulting in the body producing natural substances, such as pain-relieving endorphins. It is likely that these naturally released substances are responsible for the beneficial effects experienced with acupuncture.

A course of acupuncture usually creates longer lasting pain relief than when a single treatment is used.

How Can Acupuncture Help Pain Relief?

“Many studies (27 in total) showed that acupuncture reduced pain and improved quality of life in the short term (up to 3 months) compared with usual care or sham acupuncture.” (NICE, 2021).

There are a variety of conditions and symptoms where acupuncture can provide relief, including:

Allergies.
Anxiety and depression (Sniezek and Siddiqui, 2013).
Osteoarthritis (Vickers et al., 2012).
Chronic pain (Vickers wt al., 2012), often in the neck, back, knees, and head.
Hypertension.
Insomnia (Cao et al., 2009).
Menstrual cramps and PMS (Habek, Habek & Babrir, 2002).
Migraines (Zhao et al., 2017).
Morning sickness.
Sprains.
Strokes.

What about Acupuncture and the Military?

Chronic pain is a serious problem for combat veterans and soldiers. In a sample of 2597 soldiers who had served in Afghanistan and Iraq, 44% reported pain lasting for more than 3 months, half of whom reported pain for 1 year or more. Pain medications, including opioids, often have limited efficacy and may impose unwanted adverse effects. These limits explain the Department of Defense and the Veterans Administration’s interest in nonpharmacologic interventions including acupuncture.2 As traditionally practiced, acupuncture involves a complex assessment and individualized treatment by trained providers (300 hrs required for physicians), which are barriers to widespread implementation in military and veteran settings. (Levy, Casler & Fitzgerald, 2018).

First developed in 2001 (Niemtzow, 2007), Battlefield Acupuncture (BFA) is an Auriculotherapy (also called ear acupuncture or auricular acupuncture) protocol that was invented by Dr. Richard Niemtzow MD. He came up with the name BFA for the simple reason that it could be used on the battlefield when it was not advisable to use western pain medications. The BFA Protocol uses French auriculotherapy needles called ASP® needles.(Semi-Permanent Needle, “A” is for Aiguille, meaning needle in French)

Although the evidence base for BFA is still meagre, anecdotal evidence suggests it can reduce pain for those with headaches, acute and chronic back and musculoskeletal pain, and neuropathic pain (Levy, Casler & Fitzgerald, 2018).

What about Acupuncture and Exercise?

Research suggests that acupuncture is effective in decreasing the effects of delayed onset muscle soreness (DOMS) produced by exercise (Lin & Yang, 1999).

Other research suggests there is “strong evidence that acupuncture is significantly more effective than sham and control in enhancing recovery HR [heart rate] and blood lactate following intense exercise. However, there is conflicting evidence with regards to the effect of acupuncture on enhancing VO2 max in athletes.” (Bailey & Liddington, 2021).

There is also some evidence that acupuncture, in addition to exercise and diet, may provide effective improvement in weight control (Sezgin & Kaplan, 2021).

Are there any Risk Factors to Consider?

There are a number of risk factors to be aware when considering acupuncture (NHS, 2019):

When performed by a qualified practitioner, acupuncture is generally very safe.
Rarely, some people experience mild, short-term side effects such as: pain where the needles puncture the skin; bleeding or bruising where the needles puncture the skin; drowsiness; feeling sick; feeling dizzy or faint; and/or worsening of pre-existing symptoms.
If you have a bleeding disorder, such as haemophilia, or are taking anticoagulants, talk to a medical professional before you have acupuncture.
Acupuncture is also not usually advised if you have a metal allergy or an infection in the area where needles may be inserted.
It is generally safe to have acupuncture when you are pregnant. However, let your acupuncture practitioner know if you are pregnant because certain acupuncture points cannot be used safely during pregnancy.

Summary

Whilst acupuncture is not a cure-all therapy (still take your medication if prescribed), it is recognised as safe and beneficial for many conditions. Although it may not eliminate your symptoms, it could still ease them (which can be beneficial for those experiencing chronic pain).

Regardless of whether you are sceptical or not, speak to a medical professional regarding your concerns or any questions you may have. They can look at your symptoms, medical history, and overall health to help you determine if acupuncture is right for you.

References

Bailey, S.D. & Liddington, B. (2021) Effect of Acupuncture on Physiological Response to Exercise: A Systematic Review. International Journal of Sports and Exercise Medicine. 7(6), pp.210-219.

Cao, H., Pan, X., Li, H. & Liu, J. (2009) Acupuncture for Treatment of Insomnia: A Systematic Review of Randomized Controlled Trials. Journal of Alternative and Complementary Medicine. 15(11), pp.1171-1186.

Habek, D., Habek, J.C. & Barbir, A. (2002) Using Acupuncture to Treat Premenstrual Syndrome. Archives of Gynecology and Obstetrics. 267(1), pp.23-26.

Levy, C.E., Casler, N. & Fitzgerald, D.B. (2018) Battlefield Acupuncture: An Emerging Method for Easing Pain. American Journal of Physical Medicine & Rehabilitation. 97(3), pp.e18-e19.

Lin, J-G. & Yang, S-H. (1999) Effects of Acupuncture on Exercise-Induced Muscle Soreness and Serum Creatine Kinase Activity. The American Journal of Chinese Medicine. 27(03n04), pp.299-305.

NHS (National Health Service). (2019) Acupuncture. Available from World Wide Web: https://www.nhs.uk/conditions/acupuncture/. [Accessed: 11 November, 2022].

NICE (National Institute for Health and Care Excellence). (2021) Chronic Pain (Primary and Secondary) in Over 16s: Assessment of all Chronic Pain and Management of Chronic Primary Pain. Available from World Wide Web: https://www.nice.org.uk/guidance/ng193. [Accessed: 11 November, 2022].

Niemtzow, R. (2007) Battlefield Acupuncture. Medical Acupuncture. 19, pp.225-228.

SIGN (Scottish Intercollegiate Guidelines Network). (2013) SIGN 136 – Management of Chronic Pain – A National Clinical Guideline. Available from World Wide Web: https://www.sign.ac.uk/assets/sign136.pdf. [Accessed: 11 November, 2022].

Sniezek, D.P. & Siddiquo, I.J. (2013) Acupuncture for Treating Anxiety and Depression in Women: A Clinical Systematic Review. Medical Acupuncture. 25(3), pp.164-172.

Sezgin, Y. & Kaplan, A.K. (2021) Impact of Aerobic Exercise and Acupuncture Treatment on Obese Patients; A Retrospective Case-Controlled Study. Journal of Pharmacopuncture. 24(2), pp.54-58.

UHS (University Hospital Southampton NHS Foundation Trust). (2019) Patient Information Factsheet – Pain Relief at Home. Available from World Wide Web: https://www.uhs.nhs.uk/Media/UHS-website-2019/Patientinformation/Surgery/Pain-relief-at-home-2940-PIL.pdf. [Accessed: 11 November, 2022].

Vickers, A.J., Cronin, A.M., Maschino, A.C., Lewith, G., MacPherson, H., Foster, N.E., Sherman, K.J., Witt, C.M. & Linde, K. (2012) Acupunture for Chronic Pain: Individual Patient Data Meta-Analysis. Archives of Internal Medicine. 172(19), pp. 1444-1453.

Zhao, L., Chen, J., Li, Y., Chang, X., Zheng, H., Gong, B., Huang, Y., Yang, M., Wu, X., Li, X. & Liang, F. (2017) The Long-Term Effect of Acupuncture for Migraine Prophylaxis. JAMA Internal Medicine. 177(4), pp.508-515.