Complementary Therapies for Chronic Pain: The Case for Acupuncture

Abstract

Many patients with chronic pain turn to complementary therapies as part of their search for relief. In the USA, for example, use of complementary therapies was reported by 52% of 463 chronic patients in primary care (current use) [1], 82% of veterans with chronic noncancer pain (ever used) [2] and 35–39% of patients attending pain clinics [3]. Among US users of complementary therapies, pain conditions, including back and neck pain, joint problems and arthritis, are among the ten most common reasons for use [4]. In a survey of Europeans with chronic pain, 69% of respondents used nondrug treatments [5]. Acupuncture was one of the most popular nondrug treatments (used by 13%). Acupuncture is a complementary medical therapy that has received considerable attention in western countries over the last few decades and is growing in popularity [4]. Like other complementary therapies, it is used frequently for chronic pain [6]. However, acupuncture remains contro­ versial among many researchers and some physicians. Why is this? An ideal treatment for pain would outperform placebo in efficacy trials, provide clear clinical benefit under real life conditions, have a clearly understood biological mechanism, have a good safety record, be cost effective, be acceptable and accessible to patients and physicians, and facilitate or promote self­management. In addition, if used as part of an integrative treatment approach, it should lead to reductions in the use of harmful treatments. How does acupuncture perform when assessed using these criteria? Over 70 systematic reviews of acupuncture for a variety of pain conditions have been published [7]. Many of the primary studies have been small, poor quality trials. At least some of the systematic reviews for the same pain condition have come to opposite conclusions (e.g., temporomandibular disorder) [8,9]. Overall, acupuncture does not consistently outperform ‘placebo’ or ‘sham’ acupuncture [10,11]. In a meta­ana­ lysis using the gold standard of individual patient data from nearly 18,000 patients and 29 randomized trials, Vickers et al. found that the specific effects of acupuncture compared with sham were small and of questionable clinical significance [12]. Thus, acupuncture’s performance relative to placebo or sham is unclear.