Emergency doctors are using Acupuncture to treat pain, now here’s the evidence

Emergency medicine is not all about life and death situations and high-tech solutions. Our study, the largest of its kind in the world, shows using acupuncture in the emergency department can relieve acute pain.

The study, published today in the Medical Journal of Australia, finds acupuncture is as effective as medication in treating pain for lower back pain and ankle sprain. But it took more than an hour for either to provide adequate pain relief.

Our study builds on previous research to show the effectiveness of acupuncture to treat chronic (long-term) pain.

Yet, there are several barriers to using acupuncture routinely in emergency departments.

What is acupuncture and who practices it?

Using acupuncture to relieve pain involves placing needles in various parts of the body to stimulate the release of endorphins and other neurochemicals, which can act as the body’s naturally occurring pain relievers.

For generations various cultures around the world have used acupuncture to treat multiple conditions, including providing pain relief. And in Australia, it is reimbursed through the Medicare Benefits Schedule when administered by a medical doctor.

Further reading: Modern acupuncture: panacea or placebo?

Acupuncture is one of the most accepted forms of complementary medicine among Australian general practitioners. It also appears in treatment guidelines for doctors in how to manage pain.

Why we ran the study and what we did

Anecdotally, we were aware that several emergency department doctors, in both public and private hospitals in Australia, were treating patients’ pain with acupuncture. But until this large federally-funded study, no-one had set up a trial like it to show how effective it was.

Our trial was an “equivalence” study, which means we aimed to see if the different treatments were equivalent rather than seeing if they were better than placebo. We did this as it would not be ethical to give a placebo to people coming to an emergency department for pain relief.

So, we randomly assigned more than 500 patients to receive standard painkillers, standard painkillers plus acupuncture, or acupuncture alone when they presented with back pain, migraine or ankle sprain at four Melbourne hospitals (some private, some public). While the patients knew which treatment they had, the researchers involved in assessing their pain didn’t (known as a single-blind study).

The type of acupuncture we used included applying needles at specific points on the body for each condition, as well as along points chosen by the treating acupuncturist. This was to reflect what would happen during regular clinical practice.

Doctors who were also qualified medical acupuncturists and practitioners of traditional Chinese medicine (registered in Victoria with the Chinese Medicine Registration Board of Australia) performed the acupuncture.

After treatment, we assessed patients’ pain after an hour, and every hour until discharge. We also rang them for an update 24-48 hours after being discharged.

What we found

We found acupuncture, either alone or with painkillers, was equivalent to drugs-alone in providing pain relief for lower back pain, ankle sprain, but not for migraine.

When patients looked back on their treatment, the vast majority (around 80%) were satisfied with their treatment regardless of which treatment they had.

However, no treatment provided good pain relief until after the first hour.

What are the implications?

Our findings suggest acupuncture may be a viable option for patients who come to the emergency department for pain relief. This is especially important for those who cannot or choose not to have analgesic drugs.

This is also an important finding in light of the potential for side effects and abuse with opioid analgesics, which might otherwise be used to relieve pain in the emergency department.

Previous research shows using acupuncture to treat chronic pain is comparable to morphine, is safer and doesn’t lead to dependence. Our findings suggest acupuncture also has a role in treating acute pain.

However, our research raises several issues, not only about conducting such research but also in implementing our findings in practice.

We had to overcome many ethical, policy and regulatory issues before we started. These included issues around the qualifications of medical and non-medical acupuncturists and employing traditional Chinese medicine practitioners to deliver acupuncture in a western medical hospital.

And to more widely implement our findings, we need to discuss the type of practitioners best placed to deliver acupuncture in hospital, what type of training they need to work in the emergency department and what type of conditions they should treat.

Hopefully, our study will spark further research to address these issues and lead to the development of safe and effective protocols for acute pain relief that may involve combining both modern and ancient forms of medicine to achieve rapid and effective analgesia for all emergency department patients.

This article originally appeared on theconversation.com

Acupuncture During Pregnancy

Whether you're getting poked with a needle or pressed by a finger, these methods have been shown to relieve nausea and other pregnancy symptoms — and labor pain to boot.

WHAT IS ACUPUNCTURE?

Acupuncture is a healing art that originated in China thousands of years ago. Traditional Chinese medicine views the body as two opposing forces, yin and yang. When an imbalance occurs between the two, it blocks what Chinese medicine refers to as qi (pronounced CHEE), or the flow of vital energy along internal pathways (known as meridians) in our bodies. During acupuncture, a practitioner inserts hair-thin needles through the skin at points along the meridians to correct imbalances and restore health.

So does it work? Researchers have found that acupuncture points correspond to deep-seated nerves, so that when the needles or twirled or electrically stimulated (known as electropuncture), the nerves are activated. This, in turn, triggers the release of several brain chemicals, including endorphins, which block pain signals and help to relieve a number of pregnancy symptoms.

BENEFITS OF ACUPUNCTURE DURING PREGNANCY

Many people credit acupuncture for easing a wide range of pregnancy symptoms including heartburn, swelling in the legs, constipation, carpal tunnel syndrome, sciatica and more.

Here are some of the pregnancy symptoms acupuncture can relieve that science has studied:

• Morning sickness. Some studies have shown that traditional acupuncture that targets the wrist can reduce the nausea and vomiting associated with morning sickness.
• Lower back and pelvic pain. Research published in the American Journal of Obstetrics & Gynecology reports acupuncture could reduce pain in the lower back along with pelvic pain. Pregnant women in their late second and third trimesters received acupuncture on points on the ear; sham acupuncture (so-called “fake” acupuncture, done at nonspecific points); or no treatment at all. At the one-week follow-up, about 80 percent of women in the acupuncture group had a clinically significant reduction in pain, compared to 56 percent in the sham acupuncture group and only 36 percent for the group who received no treatment.
• Depression. Depression during pregnancy is common, affecting nearly one in four women — but a targeted type of acupuncture may help. For a study published in the journal Obstetrics & Gynecology, during eight weeks clinically-depressed pregnant women who weren’t previously taking antidepressants received general acupuncture, acupuncture specific for depression, or massage. The severity of depression symptoms decreased most among women who received acupuncture for depression. And 63 percent of the women who received the depression-specific acupuncture responded to the treatment, compared to 44 percent in the general acupuncture and massage groups.
• Headaches. Research has shown that acupuncture can reduce pregnancy-induced headaches; women who received it also used less medication.
• Sleep Problems. Getting to sleep and staying asleep is trickier than ever during pregnancy — but some research has shown that women who receive acupuncture sleep better during pregnancy, too.

MOXIBUSTION DURING PREGNANCY

Moxibustion works on the same basic principles as acupuncture, but instead of actually puncturing your skin with a needle, long sticks of the mugwort herb are burned near certain acupuncture points along your body. Both the heat from the burning and properties of the herb itself are thought to provide physical benefits. Some studies have shown that daily sessions of moxibustion (either alone or combined with acupuncture) can increase fetal activity and therefore help turn a baby from a breech position to the more delivery-friendly heads-down position. However, some others studies have found moxibustion to be no more effective than doing nothing.

ACUPRESSURE DURING PREGNANCY

The points treated in acupressure are usually the same areas used in acupuncture — but instead of using needles, pressure is applied through a firm massage. Fingers (especially thumbs), hands, elbows, knees and feet are used as tools to rub, knead, drum on and vibrate against skin on certain parts of the body. Shiatsu, the most well-known style of acupressure, is fairly vigorous, with the therapist applying firm pressure to each trigger point for three to five seconds. Studies have shown that acupressure can help ease lower back pain, labor pain, nausea and headaches, as well as help naturally induce labor and reduce stress and anxiety during labor.

A word of warning: Since the practitioner has to press and massage very deeply to reach the acupuncture points during acupressure, it’s often times more painful than acupuncture, and it can cause discomfort or leave bruising.

POSSIBLE RISKS OF ACUPUNCTURE AND ACUPRESSURE DURING PREGNANCY

When done properly by a trained professional, acupuncture during pregnancy is considered safe and has few risks. Most risks are associated with acupuncture in general, such as soreness, redness or infection at the insertion sites, and injury from needles placed too deeply.

The biggest concern during preganncy is where the acupuncture is performed: There are several acupuncture and acupressure points (like those in the ankle) that are said to induce contractions — which is why they should be avoided until term (at which point, impatient moms might want to give them a try at the hands of a professional).

ACUPUNCTURE TIPS FOR PREGNANT WOMEN

Interested in acupuncture to relieve pregnancy symptoms? A few rules of the road:

• Check with your doc. If you’re considering acupuncture, talk about it with your practitioner first. Though these therapies are generally considered safe, it’s best to discuss any health conditions, medications or other issues to determine if acupuncture is right for you.
• Choose an acupuncturist wisely. Look for one who’s licensed by his or state and certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). Make sure your therapist has extensive experience dealing with pregnant women. If you need help finding an acupuncturist, try asking your local doula association for recommendations or using the NCCAOM practitioner search page.
• Consider costs. Before you begin the treatment, ask the acupuncturist about the number of treatments you may need and how much each costs. Check with your insurer, too — some cover the cost of acupuncture while some don’t — to determine if you’ll have to pay out of pocket.
• Watch for signs of trouble. Unless you’re specifically hoping to induce labor at term, you shouldn't feel any unusual contractions during or after a session. If you do, or you notice any other concerning symptoms, contact your healthcare provider immediately.

This article originally appeared on whattoexpect.com