Acute & Chronic Pain

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Many of us suffer from occasional transient pain in the neck, shoulders, back (with or without radiation to the legs), knees and of course head, including migraines.  Usually the pain just goes away, sometimes it may come back, however, there are many cases where it persists and becomes a chronic pain. The American Medical Association estimates that about 25% of Americans suffer from chronic pain and this leads to expenditure of about $600 billion a year, half of which are treatment-related expenses and half of which are indirect expenses from loss of working days and productivity (1,2).

Beyond the pain itself, the impairment of functional ability affects also the overall quality of life and may cause depression, anxiety and insomnia.  It is perhaps not surprising that those who suffer from chronic pain search for every possible solution.

How is acute and chronic pain being treated?

here are many painkiller medications available, for both acute and chronic pain. These include non-steroidal anti-inflammatory drugs [NSAIDs - aspirin, ibuprofin, Arcoxia ,Atopen], opiates [tramadol, codin, oxycodone, morphine] and skeletal muscle relaxants [SMRs]. In addition, there are also non-drug treatment options such as physiotherapy, acupuncture, massage, exercise and more. The preferred treatment method is determined after an accurate diagnosis that includes, among other things, the duration of the pain, location of the pain, whether the pain is radiating or not, the patient's age, background diseases and other medications that the patient is taking.

Most of the abovementioned drugs have demonstrated efficacy, but their side effects can be, in some cases, severe and may even cause addiction and death following regular and prolonged use. A study from Denmark published in 2017 in the European Heart Journal involving 29,000 patients found that the use of over-the-counter NSAIDs, such as Neurofen, Advil and Diclofenac, increased the risk of cardiac arrest by 31-50% (3). A Canadian study published in the British Medical Journal involving 446,763 patients showed similar results with short-term use of these drugs of only 7 days (4). At the same time, the use of opiate drugs has made headlines since over 400,000 Americans have died from the use of these drugs in the last decade and, according to authorities, every 3 minutes a woman is admitted to ER for misuse of such drugs (5).

Following these developments, the US Food and Drug Administration (FDA) issued new guidelines for physicians treating chronic pain, to consider recommending non-drug alternatives such as acupuncture and chiropractic methods as first line of treatment (6). In Israel, too, due to the significant increase in the use of addictive narcotics, the Ministry of Health changed its prescription guidelines for pain management (7).

So what's the solution? Chinese medicine

Chinese medicine has existed for over 3,000 years and includes acupuncture, herbs, nutrition and additional manual methods such as Shiatsu and Tuina. Acupuncture has been proven to be highly beneficial in both the short and long term in treating chronic back, neck, shoulder and knee pain and without any side effects.

In the treatment of chronic back pain, a large-scale study involving thousands of patients showed that acupuncture both reduces pain and improves functioning ability (8). Another review study comparing the size of clinical efficacy in reducing pain due to osteoarthritis of the knee found that opiates were indeed highly effective (but accompanied by issues of side effects, addiction and increased mortality), while acupuncture was second in efficacy, followed by common pain killers such as Arcoxia and Neurofen, as well as aerobic exercise and weight loss (9).

Due to these and other clinical studies, in 2017, the American College of Physicians published in the prestigious  Annals of Internal Medicine, a clear recommendation for acupuncture to be used as one of the first-line treatment options for lower back pain prior to any medication (2).

So, how does acupuncture work?

Chinese medicine treatment begins with an accurate diagnosis that includes comprehensive questioning, assessment of pulse quality and observation of the tongue. This diagnosis allows for a customized treatment that includes inserting ultra-thin disposable needles that are usually not felt, to certain points on the patient's body, which, according to Chinese medicine, have been shown to be effective in reducing pain and supporting the body's healing process.  The needles remain for about 20-30 minutes. 

According to Chinese medicine, there are 365 acupuncture points along different channels, or meridians, through which the "Qi" flows - the energy or "battery" that allows us to do all the activities we do throughout the day. When Qi is stuck, pain is created. Numerous animal and human studies have examined acupuncture’s pain reducing and healing actions,. These studies have shown that certain points cause the release of endorphins (painkillers), suppress proteins that contribute to the inflammatory response and pain sensation such as Substance P, and increase the production of endogenous cannabinoids close to the site of pain (10). This mechanism of action approximates the way drugs work but without side effects.

Chinese and Japanese medicine treatment is suitable for anyone suffering from acute or chronic pain in the back, knees, neck or shoulders, whether from a traumatic or neurological injury or a prolonged illness such as fibromyalgia.

Research Bibliography:

1. Gaskin DJ and Richard P (2012) Journal of Pain 13 (8): 715-724 doi: 10.1016/j.jpain.2012.03.009

2. Qaseem A., et al. (2017) Ann Intern Med doi: 10.7326/M16-2367

3. Sondergaard KB, et al. (2017) European Heart Jl-Cardiovascular Pharmaco doi: 10.1093/ehjcvp/pvw041

4. Bally M, et al. (2017) British Medical Journal doi: 10.1136/bmj.j1909

5. https://www.cdc.gov/vitalsigns/prescriptionpainkilleroverdoses/index.html

6. https://www.fda.gov/downloads/Drugs/NewsEvents/UCM557071.pdf

7. https://www.calcalist.co.il/local/articles/0,7340,L-3758386,00.html

8. Liu L et al. (2015) Evidence-Based Complement and Alt Med doi: 10.1155/2015/328196

9. Birch S. et al. (2017) J Alt Complement Medicine 23 (4): 242-246 doi: 10.1089/acm.2016.0385

10. Zhang R. (2014) Anesthesiology 120 (2): 482–503. doi: 10.1097/ALN.0000000000000101

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