Acupuncture pain relief for lower back pain, osteoarthritis of the knee, neck pain, jaw pain, sciatica and shoulder pain

acupuncture pain relief

Acupuncture pain relief is at hand for chronic pain associated with musculoskeletal pain

Acupuncture pain relief enjoys moderate to strong evidence to support its use in the treatment of a variety of chronic painful musculoskeletal conditions.

What is the history behind acupuncture pain relief therapy

Acupuncture pain relief therapy is taught to student acupuncturists because acupuncture has had a long association with pain relief.

However, the growth of an evidence base to support acupuncture pain relief therapy is recent and an emerging field.

From a ‘Western’/biomedical perspective, how is pain classified?

When you experience pain and you attend to your GP or preferred physiotherapist, their first port of call will be to take a detailed case history.  This case history might include:

  • any known causes – like an injury
  • a timeline of events
  • understanding what aggravates your condition and what makes it feel better
  • range of motion (R.O.M.) tests to assess mobility and also potential affected joints or soft tissue
  • radiography (including x-ray, ultrasound, scans and mRI)

Pain itself is classified as being acute or chronic and often your practitioner will ask you to grade your pain on a scale of 1-10.

There is a similar ‘diagnostic’ and classification process used by acupuncture and Chinese medicine practitioners.

How does the acupuncture and Chinese medicine practitioner approach acupuncture pain relief therapy?

The acupuncturist will ask questions about:

  • timeline:  the onset of your symptoms, any significant event associated with the pain (for example, an injury) and how the pain has changed over time
  • location of pain:   where does it hurt most; does the pain migrate around your body or is it fixed in one spot?
  • nature/quality of pain:  is your pain dull in nature or stabbing or a combination of both;  does your pain burn or does it ‘shoot’ (for example, down your leg)
  • better/worse scenarios:  what helps your pain or what makes it worse (for example, movement/rest; hot/cold etc)

As a diagnostic model, Chinese medicine’s consideration of ‘location’ is quite different from the biomedical approach.

Acupuncturists rely on acupuncture channels or meridians to help them locate and label pain.  Many of these meridians track near major muscles groups or nerve pathways – although one must take care not to treat one as a substitute for the other.

Locating pain, according to the meridian/channel system, is one of the strengths of the acupuncture pain relief diagnostic and treatment model.

Will the acupuncture and Chinese herbal medicine practitioner only ask questions about my pain?

The acupuncturist will consider your pain as the main complaint.  Initial assessment will involve enquiry about the pain.  Further assessment may involve other questions about other areas of your health.

For example, if you pain is related to headache or chronic migraine and you are female, then questions about your reproductive function and menstrual cycle would be in order.

If your pain relates to osteoarthritis of the knee, and you are carrying a little extra weight, then questions about diet, and digestion would be appropriate and necessary to guide the practitioner towards constructing a Chinese medicine diagnosis.

What happens once all the information has been gathered (the Chinese medicine diagnosis).

The Chinese medicine diagnosis is unique to the practice of Chinese medicine.

This diagnosis does not replace any diagnosis given to you by your doctor, rather it sits alongside that diagnosis.

The purpose of the Chinese medicine diagnosis is to guide the practitioner towards a principle of treatment.

The principle of treatment helps the acupuncturist select the most appropriate acupuncture points, and treatment strategy, for your acupuncture pain relief therapy.

The Chinese medicine diagnosis is arrived at after all the information required for the diagnosis is gathered by way of question and answer and palpation of your body.

The practitioner will then carefully analyse that information, in accordance with Chinese medicine principles, and from that arrive at a Chinese medicine diagnosis.

What evidence is there to support acupuncture pain relief therapy?

Across 2016 and early 2017, Australian researchers conducted a review of the highest evidence possible to support the use of acupuncture pain relief therapy 1

Contained within this evidence review are evidence summaries of systematic reviews and other ‘level I’ forms of evidence.

The following conditions have ‘strong’ evidence to support acupuncture as a primary form of treatment.

CHRONIC LOWER BACK PAIN

The Australian Department of Veteran’s Affairs review into alternative therapies (2010) concluded acupuncture as a treatment for chronic lower back pain as ‘possibly effective’ 2

A similar review by the  United States Department of Veterans Affairs (2014) concluded acupuncture as a treatment for lower back pain to be ‘unclear’. 3

The United States Agency for Healthcare Research and Quality (2016) 4 concluded there is moderate evidence for acupuncture pain relief therapy.

An extensive systematic review, which collated data from thirty-two randomised controlled trials covering non-specific lower back pain concluded that acupuncture was statistically and clinically superior to ‘sham’ acupuncture in reducing pain and increasing mobility. 5

‘Sham’ acupuncture is a ‘fake’ type of acupuncture used in clinical trials to assess whether ‘real’ acupuncture works.

A narrative review of non-invasive and alternative treatments for chronic lower back pain rated the evidence supporting acupuncture pain relief as high (and for acupressure, moderate). 6

Finally, a review of sixteen systematic reviews (2015) 7 demonstrated that acupuncture administered alone, or with usual care (medical care), demonstrated short-term improvement in pain and function.

This review recommended acupuncture pain relief therapy as routine clinical practice for chronic lower back pain.

OSTEOARTHRITIS OF THE KNEE

The Australian DVA Review (2010) did not collate data on acupuncture for osteoarthritis of the knee but the  2104 USVA evidence map did and concluded there is ‘evidence of potential positive effect’.

A network meta analysis 8 ranked ‘real’ acupuncture as superior against other interventions including sham acupuncture ,muscle strengthening exercises, Tai Qi, weight loss, standard care and aerobic exercise (in that order).

This same study ranked acupuncture as equally effective against balneotherapy (bathing in minerals).  A sub-analysis of this study also demonstrated acupuncture to be superior to standard and muscle strengthening exercise.

A systematic review of twelve randomised controlled trials 9 concluded that “current evidence supports the use of acupuncture as an alternative for traditional analgesics in patients with osteoarthritis” because it reduces pain intensity, increases mobility and improves quality of life.

POST-OPERATIVE PAIN

The Australian DVA review (2010) did not review acupuncture pain relief for post-operative pain and the US DVA map of evidence (2014) stated the evidence for acupuncture as pain relief for post-operative pain as being ‘unclear’.

A 2016 systematic review and meta-analysis 10 demonstrated that acupuncture pain relief administered on day one after surgery reduced pain and reduced opioid use.

For acute post-operative pain associated with back surgery there is encouraging, but limited (due to sample size), evidence to support acupuncture as a therapy in a systematic review of five randomised controlled trials (including three high quality trials) 11.

Two other randomised controlled trials 12 and 13 demonstrated reduced reliance on ibuprofen (2013) and fentanyl (2015) when acupuncture was used for post-operative pain relief.

ACUTE LOWER BACK PAIN

The Acupuncture Evidence Project lists evidence supporting  acupuncture pain relief therapy for acute lower back pain as ‘moderate’.

The US Agency for Healthcare Research and Quality report says evidence is low and a 2006 Cochrane Review cited in that same review made no firm conclusion of acupuncture as a therapy for acute lower back pain.  However, a 2013 systematic review of eleven randomised controlled trials concluded that acupuncture for pain relief was superior to non steroidal anti-inflammatory drugs (although the effect was small). 14

The following conditions are cited by the Acupuncture evidence project (2017) as having moderate level evidence to support the use of acupuncture in their treatment.

UPPER BODY

NECK PAIN

While acupuncturists are regularly consulted for neck pain, the evidence to support its use as a therapy is listed by the Acupuncture Evidence Project (2017) as ‘moderate/potential positive’.

The Australian DVA review (2010) said the evidence was insufficient while the US DVA Evidence mapping project (2014) was unclear.  Three subsequent systematic reviews have produced mixed evidence outcomes.

One 2014 study 15 had low quality evidence and limited evidence of effectiveness for acupuncture after whiplish injury.

Another systematic review (2015) rated the evidence supporting acupuncture v. sham acupuncture for neck pain as being of “moderate quality” 16 while another study 17 rated acupuncture with standard care as cost-effective for patients.

LATERAL ELBOW PAIN

Lateral elbow pain may include conditions like ‘tennis elbow’.

The Acupuncture Evidence Project (2017) upgrades the evidence for acupuncture as a line of treatment to ‘potential positive’.

Earlier reviews from the Australian DVA (2010) and US DVA Evidence mapping project (2014) says the evidence in insufficient and not reviewed.

Two subsequent studies reflect the low grade evidence available including one study citing moderate evidence 18 and another citing insufficient evidence 19

SHOULDER PAIN

A 2015 systematic review 20, including two high quality acupuncture studies, recommended acupuncture in conjunction with exercise for early stage shoulder impingement syndrome (SIS).  This evidence builds on earlier insufficient and unclear evidence summaries.

TEMPOROMANDIBULAR JOINT DYSFUNCTION (TMJD)

The USVA Evidence map (2015) listed acupuncture pain relief therapy for TMJ as ‘potential positive effect’.  This conclusion was further supported in a 2015 randomised controlled trial demonstrating acupuncture as effective as occlusal splint for TMJ pain. 21

LOWER BODY

PLANTAR HEEL PAIN (Plantar Fasciitis)

The 2015 USVA evidence map lists acupuncture for plantar heel pain (plantar fasciitis) as potential positive.  No further studies of acceptable evidence standard have been completed since this study.

SCIATIC PAIN

Three recent (2015) high quality reviews of evidence rate acupuncture favourably in the treatment of sciatic pain.

One study (a network meta analysis) of  rates acupuncture as the 2nd most effective therapy (out of twenty-one) for overall global effect and improvement in pain intensity 22

Another systematic review and meta analysis of eleven randomised controlled trials 23 showed acupuncture may be superior to and enhance the effects of, pain medication.  The study rated the evidence as being of low quality.

A third systematic review of twelve randomised controlled trials 24 demonstrated acupuncture’s superiority over conventional drug treatment, on a lower quality evidence base, for outcome effectiveness, pain intensity and pain threshold.

I feel as though I need to know a little more about understanding evidence.

For those not familiar with it, interpreting evidence can be daunting and confusing.

There is an extensive discussion around the use of evidence in supporting acupuncture over on this FAQ page.

What if my condition isn’t listed on this page?

All that means is that there hasn’t been enough research to officially say, “yep it helps”.

Before deciding whether acupuncture pain relief is for you, feel free to give Peter a call to chat about your individual circumstances and his experience or knowledge of your problem.

Ready to book your first consultation?

Peter Kington, Brisbane acupuncture practitioner, offers a range of days and appointment times for your first and follow-up consultations. Call (07) 3367 1150 or contact Peter hereand he or an associate will call you back, have a quick chat about your needs and find a mutually convenient time for your first appointment.

  1.  MacDonald J, Janz S.  The Acupuncture Evidence Project:  A Comparative Literature Review (revised evition).  Brisbane:  Australian Acupuncture and Chinese Medicine Association Ltd;  2017.  [accessed 21 February, 2018.
  2. Biotext. Alternative therapies and Department of Veterans’ Affairs Gold and White Card arrangements. In: Australian Government Department of Veterans’ Affairs, editor: Australian Government Department of Veterans’ Affairs; 2010.
  3. Hempel S, Taylor SL, Solloway MR, Miake-Lye IM, Beroes JM, Shanman R, et al. VA Evidence-based Synthesis Program Reports. Evidence Map of Acupuncture. Washington (DC): Department of Veterans Affairs; 2014.
  4. Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, et al. AHRQ Comparative Effectiveness Reviews. Noninvasive Treatments for Low Back Pain. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016.
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  8. Corbett MS, Rice SJ, Madurasinghe V, Slack R, Fayter DA, Harden M, et al. Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis. Osteoarthritis Cartilage. 2013 Sep;21(9):1290-8
  9. Manyanga T, Froese M, Zarychanski R, Abou-Setta A, Friesen C, Tennenhouse M, et al. Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis. BMC Complement Altern Med. 2014;14:312.
  10. Wu MS, Chen KH, Chen IF, Huang SK, Tzeng PC, Yeh ML, et al. The Efficacy of Acupuncture in Post-Operative Pain Management: A Systematic Review and Meta-Analysis. PLOS ONE. 2016;11(3):e0150367.
  11. Cho YH, Kim CK, Heo KH, Lee MS, Ha IH, Son DW, et al. Acupuncture for acute postoperative pain after back surgery: a systematic review and meta-analysis of randomized controlled trials. Pain Pract. 2015 Mar;15(3):279-91.
  12. Barlow T, Downham C, Barlow D. The effect of complementary therapies on post-operative pain control in ambulatory knee surgery: a systematic review. Complement Ther Med. 2013 Oct;21(5):529-34.
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