Acupuncture for pain? No thanks

March 1, 2011 12:00 am Views: 2927
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Thoracodorsal nerve stimulation is demonstrated at the McMaster University Contemporary Medical Acupuncture program.

Is acupuncture a reasonably effective intervention for the treatment of pain? Advocates will tell you “yes” and show you dozens of studies to support their enthusiastic claim. Detractors will tell you “no” and quickly add that based on randomized control trials and recent meta-analyses acupuncture is no better than placebo to treat pain. As a third answer, the 29 faculty, and the more than 1,300 health professionals who have graduated from the McMaster University Contemporary Medical Acupuncture Program since 1999, will tell you simply that this has been the wrong question to ask.

Why? Because pain is a complex individual experience impossible to evaluate accurately, and the common way of measuring the perception of pain in clinical trials (the Visual Analog Scale) has shown a very poor correlation with the potentially devastating loss of function and quality of life that pain sufferers experience every day. This alone makes most studies of no clinical value, regardless of their conclusions and methodological quality.

Looking for another approach, in the last few years several studies performed in England have evaluated the cost/benefit of acupuncture for the treatment of pain compared to conventional treatments for the same conditions. The conclusions were favorable to acupuncture. However, when confronted with these new positive results, the usual theoreticians of the evidence-based movement still maintained that it is “scientifically unclear” whether acupuncture can be considered an effective therapy for the treatment of pain.

How does this all affect the millions of pain patients worldwide that apparently benefit from acupuncture every day? Actually, it does not. Why? Because acupuncture seems to work for them, and they could not care less how acupuncture really works, as long as it keeps working for them, and they plan to continue using it, as they will tell you if you ask them as we did.

What is the position of the McMaster University Contemporary Medical Acupuncture Program on this debate? It is summarized as the title of this article Acupuncture for pain? No thanks. Does this mean literally not to use acupuncture for the treatment of pain? Hardly, as health-care professionals trained through this program are among the most successful using acupuncture to treat people with pain problems. The answer? Neurofunctional acupuncture, an innovative clinical approach pioneered and systematized by the program.

A neurofunctional approach does not seek a single hypothetical source of pain; it investigates clinically the most common levels of dysfunction associated with complex pain problems, such as neurological, biomechanical, muscular, metabolic, and psychoemotional. Understanding and evaluation of these aspects allows the design of multidimensional treatment plans. Neurofunctional acupuncture interventions are used to facilitate modulation of neurological activity at multiple levels: autonomic (vascular, visceral and central), segmental somatic (propioceptive-motor, nociceptive), and supraspinal (autonomic, somatic, limbic system, cerebellum, etc.).

Neurofunctional acupuncture treatments are designed using a fully systematized practical modular approach (with local inputs, axial and trunk inputs, and systemic regulatory inputs). Clinical outcome measures used include multiple functional indicators.

Therefore, a neurofunctional acupuncture approach is fundamentally different from the “balancing the body’s energy” used by traditional acupuncturists and from the also oversimplistic evaluation of the central perception of pain tested in the randomized controlled trials of acupuncture in the last decade.

Neurofunctional acupuncture interventions do not aim at eliminating pain directly. The goal is to promote self-regulation of nervous system activity, facilitating up-and-down regulation processes such as the production and repair of myelin sheaths, the synthesis of protein-based nerve membrane ion channels, or the secretion and metabolism of neuropeptides.

In the last forty years, hundreds of basic science studies in laboratories (using human and animal models) have shown the effects of acupuncture on many neurological, cellular, and metabolic processes. However, to date, no scientific neurofunctional acupuncture approach has been systematically tested other than in clinical practice by the faculty and graduates of the McMaster University Contemporary Medical Acupuncture Program.

In the future, only the use of such a scientific model, fully reproducible and based on a neurofunctional rational, will be able to reliably test the ability of acupuncture to influence the functions of the nervous system and answer whether this ability is clinically useful. Meanwhile patients still need to alleviate their pain and suffering. Should we continue to use acupuncture? Ask them. We did, and the answer was clear. Neurofunctional acupuncture for pain? Yes, thank you.

For more information about the McMaster University Contemporary Medical Acupuncture Program go to www.contemporaryacupuncture.com or www.medicalacupuntureprogram.com or www.neurofunctionalacupunture.com or or call Valerie Cannon at 905-521-2100 x75175

Article By:

Dr. Alejandro Elorriaga Claraco

Dr. Alejandro Elorriaga Claraco is Director of the McMaster University Contemporary Medical Acupuncture Program.

4 Comments

  • I have been a clinical acupuncturist for 10 years… trained in the TCM methods as well as using Acupuncture Physiatrics for treating pain. The physiatric treatments are superior to TCM for pain because they target several components similar to what you outline in this article. However, when treating disease processes, TCM is superior. I am very disappointed that you are not recognizing that TCM has it’s place. Acupuncture is NOT just about treating pain by a long shot! I have approx a 95% success rate with all my patients regardless of what they see me for. Please don’t be short sighted. TCM acupuncture is 3500 years old, surely it accounts for something!

  • Jan, the focus of the article is on the use of a neurofunctional approach for the treatment of pain, and it did not discuss the many other applications of the same contemporary approach we use on the treatment of systemic and visceral regulatory problems, which are certainly wonderful. At any rate, when an acupuncture treatment works (regardless of how the selection of the input has been done), it is because it stimulates existing and available relevant physiological mechanisms involved in the presenting dysfunction. Therefore, the best approach to design acupuncture treatments is to understand as much as possible these mechanism of “disease” and what interventions can help the body modulate them. We have developed a 100% neurofunctional acupuncture method to the treatment of what you call disease processes that is more consistent and reliable that a TCM approach in achieving the above mentioned intended goal, but certainly TCM and other traditional approaches (Korean, Japanese, Vietnamese, French Meridian, British Five Elements, etc.) can also achieve often therapeutic success. However, that does not validate the method. The fact that you can navigate in the ocean using the constellations and arrive to port safe and sound does not validate the ideas of fixed stars hanging from a transparent sphere and forming mythological figures that dominate the lives of mortals. The sky has not change much in thousands of years, neither has human physiology. What has changed dramatically is our understanding of these very complex phenomena. You can use things and methods that produce results without ever understanding the underlying laws of nature, but as health care professionals we should strive every day to achieve greater clarity and precision on what we do. Embracing tradition because is old is a sure way to halt progress.

  • Jaroslaw Pospiech

    I admire the author’s open-mindedness and constructive approach to high quality scientific evidence. I agree that much more has to be leaned about the pain phenomenon and I am convinced that new clinical approaches will arise from that knowledge. I am particularly optimistic about the opportunities associated with FMRI. I also think that the optimism about effectiveness of the new approach to acupuncture seems a little premature. I am also a little disappointed with the use of argument from popularity (made an academic) to justify ongoing use of acupuncture for pain. Patients’ reported improvement is not negating the study results because the placebo effect is significat. The systematic review concluded that there is an improvement but no greater than a placebo. I am motivated to learn more about potential problmems with use of VAS in large systematic review. Thanks stimulating the discussion on this matter. Jaroslaw.

  • I know this initial post was from 2011, and I am curious what kind of continued research/follow up reports have been made. Could you direct me to the right place?

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