Acupuncture: A Natural Evidence-Based Alternative to Opioids for Chronic Pain Management

By:  Dr. Shamus Clancey DACM, L.Ac 

Far too many people live with chronic pain. It is estimated that over 1.5 billion people suffer from chronic pain worldwide (NCHS, 2006). In many cases, individuals have exhausted all options available to mitigate their conditions and are left with the possibility of invasive surgery, or turning to opioid based pain medication to mask the root causes of their conditions. Acupuncture, as part of the larger system of Chinese Medicine, exists as a promising evidence-based, complimentary, or alternative option for mitigating this suffering; in many cases by treating branch symptoms, as well as the root causes.

Opioid based pain medication is an option that often arises when a medical professional is out of solutions in a given treatment plan, and must make the decision to ‘treat the branch’ in order to provide a patient with immediate relief. Unfortunately however, it is becoming all too common that these medications are used as a first line of treatment, when other options are not yet exhausted or incorporated. Pain medication can be something of a modern medical miracle to provide temporary relief, however there are no guarantees of efficacy. A study by the American Pain Foundation found that only 23% of patients with chronic pain found pain medication to be effective (APF, 2006), while another meta-analysis and systemic review in 2016, appearing the the JAMA Internal Medicine, found that opioid pain medication was not effective for chronic back pain at guideline recommended dosages (Saheed, Maher, Williams, et al ., 2016). Furthermore, opioid based pain medication carries its own array of side-effects such as constipation, respiratory depression, dizziness, mental fog, and more; not the least of which being the well documented risk of addiction, which has now reached epidemic levels in the United States. Currently, it is estimated that nearly 2 million Americans are addicted to opioid based pain medications (Schuchat, Houry, Guy, 2017), and more overdose deaths occur from these medications than from heroin (Rudd, Seth, David et al., 2016).

While still in relative infancy in Western culture and consciousness, acupuncture exists as part of a complete medical system that offers natural evidence-based relief from pain. Growing in acceptance among Western biomedical professionals, acupuncture is becoming integrated into treatment plans as an option to not only treat the ‘branch’ - the resulting symptoms of a condition - but to be leaned upon to treat the ‘root’ causes of painful conditions as well. For these reasons amid the current opioid epidemic in the U.S., the Food and Drug Administration is now recommending that physicians learn more about the role that acupuncture and other complementary therapies can play in the mitigation of pain, as an alternative to opioid based prescription pain medication. 

While still not fully understood through a Western scientific lens, the evidence base of acupuncture’s efficacy is growing and it’s biomedical mechanisms are beginning to be discovered. Recently research has been conducted that maps the neural pathways from acupuncture points, to the spinal cord, to pain deactivation centers in the brain (Yin, Brucheit, Park, 2017), for this reason many posit that acupuncture has the unique effect of re-mapping the brain’s response to pain by re-routing the pathways via the act of needle insertion and stimulation at acupuncture points. This can be particularly useful in cases involving musculoskeletal systems such as chronic back, neck and shoulder pain. 

In contrast to using prescription synthetic opioids to mitigate pain, acupuncture has been shown to engage the body’s self-healing mechanisms by encouraging the body to activate its own innate natural opioids, as well as to increase the brain’s sensitivity to these opioids (Harris, Zubieta, Scott, et al. 2009). Not limited to naturally occurring opioids, acupuncture has also been shown to encourage the release of other ‘built-in’ biochemical pain reducers such as ATP, adonsinine, GABA and substance P (Zhao, 2009). When faced with potentially very dangerous procedures, or the risky and unwanted side effects of pain medication, acupuncture represents a very safe complimentary or alternative treatment that is worth exploring. 

Many patients of acupuncture will attest to the lasting relief they have gained, in some cases after only one treatment. While these accounts are common and plentiful, they are understandably not enough to satisfy those equipped with healthy skepticisms. In the largest open pragmatic study of its kind, 454,920 patients with chronic headache, back pain and osteoarthritis were treated with acupuncture, of 8727 treating physicians it was found that a “marked or moderate” decrease in pain occurred in 76% of participants (Weidenhammer, Streng, Linde, et al., 2007). In a 2 year retroactive survey published in 2016, 93% of 89,000 participating patients declared success in the reduction of chronic pain (ASHIHSD, 2016). While a strong case for acupuncture is becoming well established, more studies are warranted and are currently underway to examine its effectiveness, as well as determine the underlying mechanisms through a Western biomedical lens. 

With an opioid epidemic currently in full bloom in the United States, and a growing evidence base of efficacy, there has never been a more appropriate time to consider acupuncture as a complimentary or alternative therapy to pain medications when treating chronic pain. With a proper treatment plan that may include Chinese bodywork, Chinese herbal medicine, exercise/diet/lifestyle modifications, and acupuncture; much work can be done naturally to mitigate chronic pain via a ‘root and branch’ approach, and avoid the adverse and potentially dangerous side-effects that may arise from the use of opioid-based pain medications.

Dr. Shamus has been practicing various aspects of Chinese medicine for over a decade. He is a graduate of Pacific College of Acupuncture and Oriental Medicine's Acupuncture and Chinese medicine doctoral program. He received his Master of Science in Acupuncture from the Finger Lakes School of Acupuncture of New York State Chiropractic College, and completed his herbal studies at the Won Institute of Graduate Studies in Philadelphia, PA. His interest in Chinese medicine was sparked at an early age when an acupuncture clinic opened up next to his house. Thereafter, he began studying and practicing medical Qi Gong with 5th generation acupuncturist and medical qi gong practitioner, Grandmaster Tzu Kuo Shih, OMD, L.Ac. His circuital route from qi gong to acupuncture brought him through masonry, music production and performance, geography studies at SUNY Geneseo, and nearly a decade of organic farming; this path forged a life-long dedication to the importance that natural medicine plays in mental and physical well-being, which he currently cultivates with his patients as a licensed and board certified acupuncturist in Rochester, NY.

References:

Abdel Shaheed, C., Maher, C. G., Williams, K. A., Day, R., & McLachlan, A. J. (2016). Efficacy, Tolerability, and Dose-Dependent Effects of Opioid Analgesics for Low Back Pain: A Systematic Review and Meta-analysis. JAMA Internal Medicine, 176(7), 958–968. http://doi.org/10.1001/jamainternmed.2016.1251

American Specialty Health Incorporated Health Services Department. (2016). Acupuncture: Does Acupuncture Provided Within a Managed Care Setting Meet Patient Expectations and Quality Outcomes?, 1–12.

Harris, R. E., Zubieta, J.-K., Scott, D. J., Napadow, V., Gracely, R. H., & Clauw, D. J. (2009). Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on μ-opioid receptors (MORs). NeuroImage, 47(3), 1077–1085. http://doi.org/10.1016/j.neuroimage.2009.05.083

National Center for Health Statistics (2006) Health, United States, 2006 [Online] Available from: https://www.cdc.gov/nchs/data/hus/hus06.pdf [Accessed 25 October, 2017]

Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016;65:1445–1452. DOI: http://dx.doi.org/10.15585/mmwr.mm655051e1

Schuchat, A., Houry, D., & Guy, G. P. (2017). New Data on Opioid Use and Prescribing in the United States. Jama, 318(5), 425–426. http://doi.org/10.1001/jama.2017.8913

Weidenhammer W, Streng A, Linde K, Hoppe A, Melchart D. Acupuncture for chronic pain within the research program of 10 German Health Insurance Funds–basic results from an observational study. Complementary therapies in medicine. 2007;15(4):238-46.

Yin, C., Buchheit, T. E., & Park, J. J. (2017). Acupuncture for chronic pain: an update and critical overview. Current Opinion in Anaesthesiology, 1. http://doi.org/10.1097/ACO.0000000000000501

Zhao, Z.-Q. (2008). Neural mechanism underlying acupuncture analgesia. Progress in Neurobiology, 85(4), 355–375. http://doi.org/10.1016/j.pneurobio.2008.05.004