|
Effect Of Acupuncture On The
Quality Of Life In Patients With Chronic Pain:
A Prospective Outcome Measure
Albert Y. Leung, MD
ABSTRACT
Background Little outcome data is available to support the long-term use of medical acupuncture as an alternative or adjunctive tool in chronic pain management.
Objective To assess the benefit of acupuncture on the quality of life and pain relief in patients with chronic pain.
Design A prospective questionnaire was used to assess the response of patients with chronic pain to acupuncture.
Patients and Setting Patients with chronic non-malignant pain for longer than 2 months were eligible to receive acupuncture and participate in the survey. Participants were selected from patients at the Veterans Affairs pain clinic in San Diego, California, between June 2000 and July 2001.
Intervention Three consecutive acupuncture treatments at intervals less than 2 weeks apart were provided to the patients, who were then asked to answer the questions in the survey 1-2 weeks after the 3rd treatment.
Main Outcome Measures Categorical rating of improvement in pain relief, sleep, and sense of well-being. Quantitative reduction of analgesic use was also evaluated.
Results Of the 33 patients who completed the survey, 85% (n=28), 72.7% (n=24), and 82% (n=27) showed some degree of improvement in pain relief, sleep, and sense of well-being, respectively; 42% (n=14) of the patients were able to reduce their analgesic requirement (range,
25%-100% reduction). A total of 78.8% (n=26) indicated in the questionnaire that they wished to continue acupuncture as part of their pain treatment.
Conclusions Acupuncture can serve as an alternative or adjunctive treatment in improving quality of life in patients with chronic pain. Further research is needed to study the underlying mechanism of acupuncture for pain relief.
KEY WORDS
Acupuncture, Chronic Pain, Pain Relief, Quality of Life, Sleep Improvement
INTRODUCTION
The use of acupuncture in treating both acute and chronic pain has been aptly described in the literature.1-3 However, little outcome data is available to adequately support the role of acupuncture in a conventional (Western medicine) pain management setting. Because function and quality of life are key elements in assessing the success of pain management, the same criteria should be used to evaluate the role of acupuncture in chronic pain management.
Medical acupuncture was recently incorporated into the pain clinic at the San Diego Veterans Affairs Health Care System. The goal of the clinic is to provide comprehensive management for patients with chronic pain. We conducted a prospective study to assess the patients' response to acupuncture to validate the use of acupuncture as an alternative or adjunctive modality in this clinic.
METHODS
Participants were selected from patients at the Veterans Affairs pain clinic in San Diego, California, between June 2000 and July 2001. We used a survey that consisted of questions commonly used by pain specialists in evaluating the improvement in quality of life and functions4-6 to assess the role of medical acupuncture in chronic pain management. Patients who had given consent and received 3 initial consecutive acupuncture treatments with no more than 2 weeks between treatments were asked the following questions: (1) Do you feel your pain relief has improved with acupuncture? (2) Does acupuncture improve your sleep at night? (3) Does acupuncture improve your overall sense of well-being? If the answer to any of the questions was yes, the patients were asked to rank the degree of response as mild, moderate, or significant. In addition, a 4th question was included: Are you able to reduce your pain medication consumption? For those who elected to continue the treatment, a repeat survey was used every 6-8 weeks to continue assessing the patient response to acupuncture.
RESULTS
Over a 1-year period, a total of 42 patients received acupuncture for chronic pain. Thirty-three of them (mean age, 60 years) were able to complete the initial 3 consecutive treatments with less than 2 weeks in between, and complete the questionnaire after the 3rd treatment. Twenty-four of the patients were men and 9 were women. Among the 9 patients who did not complete the 3 consecutive treatments, 6 of them were lost to follow-up after the initial 2 treatment sessions. Two of them completed the initial 2 treatments more than 2 weeks apart and have not completed the 3 consecutive treatments; 1 patient requested to stop the therapy after the 1st treatment due to lack of efficacy. The overall "no-show" rate at the clinic is about 25%.
The 3 most common presenting diagnoses of chronic pain conditions included low back, shoulder, and neck pain. The average length of each treatment session was about 20 minutes. The purpose of the survey was mainly to obtain patient feedback of their response to acupuncture in general, rather than to compare the efficacy of any individual treatment. As a result, only the type of treatments for the corresponding chronic pain conditions is listed in Table 1.
Pain Relief
A total of 85% (28/33) of patients reported some degree of pain relief. Of these, 30.3% (10), 36.3% (12), and 18.2% (6) reported significant, moderate, and mild degrees of pain relief, respectively, vs 15.2% (5) reporting no pain relief.
Sleep Improvement
A total of 72.7% (24/33) of patients reported sleep improvement. Among the 33 patients who completed the questionnaires, 15.2% (5), 33.3% (11), and 24.2% (8) reported significant, moderate, and mild degrees of sleep improvement, respectively; 27.3% (9) reported no sleep benefit.
Improvement in Sense of Well-Being
Eighty-two percent (27/33) of the patients reported improvement in sense of well-being with the use of acupuncture. Of the 33 patients, 12.1% (4), 51.5% (17), and 18.2% (6) reported significant, moderate, and mild degrees of a sense of well-being improvement with acupuncture, respectively, while 18.2% (6) of the patients reported no noticeable improvement.
Reduction of Analgesics and Future Treatment
Forty-two percent (14/33) of the patients reduced their analgesic requirement (range, 25%-100% reduction). Among them, 8 patients completely stopped using any analgesics with the acupuncture treatment. In addition, 78.8% (26) indicated in the questionnaire that they wished to continue acupuncture as part of their pain treatment.
Acupuncture and Common Chronic Pain Syndromes
Low Back Pain
Among the 11 patients with low back pain (including 3 with failed back syndrome), 36% (4), 36% (4), and 9% (1) reported significant, moderate, and mild degrees of pain relief, respectively. Nine percent (1), 36.3% (4), and 36.3% (4) reported significant, moderate, and mild degrees of sleep improvement, respectively. In addition, 9% (1), 64% (7), and 9% (1) of patients with low back pain reported significant, moderate, and mild degrees of a sense of improvement in well-being with acupuncture treatment.
Shoulder Pain
In 7 patients who were treated for chronic shoulder pain, 28.6% (2), 14.3% (1), and 43% (3) of them reported significant, moderate, and mild degrees of pain relief, respectively. Only 1 patient with shoulder pain reported no pain relief with acupuncture treatment.
|
Table 1. Chronic Pain Conditions Treated with Medical Acupuncture
|
|
Condition
|
No. of Patients
|
Primary Treatment
|
|
Chronic low back pain
|
11
|
PENS with or without auricular acupuncture
|
|
Chronic shoulder pain
|
7
|
Barrier points with electrical stimulation
|
|
Chronic neck pain
|
8
|
PENS with or without auricular acupuncture
|
|
Other (RSD, PSCP, fibromyalgia, etc.)
|
8
|
Treatment varies with patients
|
|
PENS: percutaneous electrical nerve stimulation; RSD, reflex sympathetic dystrophy; PSCP, poststroke central pain.
|
|
In the category of sleep improvement, 5 of 7 patients reported a positive response. Among them, 14.3% (1), 28.6% (2), and 28.6% (2) reported significant, moderate, and mild degrees of sleep improvement, respectively. In addition, 6 of 7 patients (86%) noticed a benefit in their sense of well-being.
Chronic Neck Pain
Eight patients with chronic neck pain were treated with acupuncture. Seven demonstrated pain relief with acupuncture: 37.5% (3), 37.5% (3), and 12.5% (1) showed significant, moderate, and mild degrees of pain relief, respectively. Five reported sleep improvement: 37.5% (3) and 25% (2) showed a significant and moderate degree of improvement, respectively.
Seven of 8 reported an improvement in their sense of well-being: 12.5% (1), 50% (4), and 25% (2) reported significant, moderate, and mild degrees of improvement, respectively.
DISCUSSION
Despite the fact that acupuncture has been widely used in treating both acute and chronic pain conditions for many years in different parts of the world, little is known about the underlying mechanism. Due to the inherent difficulty of study design and lack of scientific data, the use of acupuncture as a treatment modality has not been widely embraced in conventional pain management clinics.7
Although no definitive conclusion can be drawn from the results of the current study, the overall findings from this prospective questionnaire suggest that in addition to the analgesic benefit, acupuncture may potentially enhance the overall quality of life in patients with chronic pain. The potential benefits of medical acupuncture in patients with chronic pain may include sleep improvement, sense of well-being, and possibly, medication reduction.
The observed benefits may provide some insight to the underlying mechanism of acupuncture. Previous studies have suggested that the analgesic mechanism of acupuncture is via a central neurohumeral mechanism such as endorphin release.8-11 Recent preliminary results from functional magnetic resonance imaging (fMRI) studies provide further evidence of the neurohumeral/central mechanism of acupuncture.12 Although the current study is a prospective survey that does not include a control group, the long-term benefit of acupuncture reported by these patients argues against a pure placebo response. Conversely, the efficacy of any particular treatment in corresponding to the particular chronic pain syndromes require more focused investigation.
CONCLUSION
Medical acupuncture can serve as an adjunctive or alternative tool in managing chronic non-malignant pain. The efficacy of specific treatments for different chronic pain conditions and the corresponding underlying mechanism require more investigation for acupuncture to gain further acceptance into the mainstream medical community.
ACKNOWLEDGEMENT
My gratitude to Sue Randolph, LVN, and Donna Clar, RN, for their clinical assistance in this study, and Linda Sutherland for her editorial assistance.
REFERENCES
- Mayer DJ. Acupuncture: an evidence-based review of the clinical literature. Annu Rev Med. 2000;51:49-63.
- Ceniceros S, Brown GR. Acupuncture: a review of its history, theories, and indications. South Med J. 1998;91:1121-1125.
- Ahmed HE, White PF, Craig WF, Hamza MA, Ghoname ES, Gajraj NM. Use of percutaneous electrical nerve stimulation (PENS) in the short-term management of headache. Headache. 2000;40:311-315.
- Bech P. Health-related quality of life measurements in the assessment of pain clinic results. Acta Anaesthesiol Scand. 1999;43:893-896.
- Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain. 1975;1:277-299.
- Williams AC. Outcome assessment in chronic non-cancer pain treatment. Acta Anaesthesiol Scand. 2001;45:1076-1079.
- Hammerschlag R. Methodological and ethical issues in clinical trials of acupuncture. J Altern Complement Med. 1998;4:159-171.
- Pomeranz B, Chiu D. Naloxone blockade of acupuncture analgesia: endorphin implicated. Life Sci. 1976;19:1757-1762.
- Cheng RS, Pomeranz B. Electroacupuncture analgesia could be mediated by at least two pain-relieving mechanisms: endorphin and non-endorphin systems. Life Sci. 1979;25:1957-1962.
- Han JS, Xie GX, Zhou ZF, Folkesson R, Terenius L. Enkephalin and beta-endorphin as mediators of electro-acupuncture analgesia in rabbits: an antiserum microinjection study. Adv Biochem Psychopharmacol. 1982;33: 369-377.
- Han JS, Terenius L. Neurochemical basis of acupuncture analgesia. Annu Rev Pharmacol Toxicol. 1982;22:193-220.
- Hui KK, Liu J, Makris N, et al. Acupuncture modulates the limbic system and subcortical gray structures of the human brain: evidence from fMRI studies in normal subjects. Hum Brain Mapp. 2000;9:13-25.
AUTHOR INFORMATION
Dr Albert Leung is a Board-certified Anesthesiologist with subspecialty training in Pain and Palliative Medicine; Assistant Professor at the University of California, San Diego (California), Department of Anesthesiology, Center for Pain and Palliative Medicine; and Staff Anesthesiologist and Director of the Anesthesia Pain Clinic at the San Diego Veterans Affairs Health Care System. Dr Leung's research interests include the study of pain and acupuncture mechanisms with the use of peripheral quantitative sensory testing and functional imaging.
Albert Y. Leung, MD*
Assistant Professor of Anesthesiology
University of California, San Diego
9500 Gilman Dr, #0924
La Jolla, CA 92093-0924
Phone: 858-657-7030 • Fax: 858-657-7035 • E-mail: ayleung@ucsd.edu
*Send all correspondence and reprint requests to Dr Leung at the address above.
|
