Posted by: Scott Stewart, MSAc., Dipl.Ac., LAc.
Chronic pain in America has become a serious national health issue that continues to grow exponentially every year. According to the Institute of Medicine (IOM) in their 2011 report on pain in America, 100 million adults are affected by chronic pain[i], although, this number is probably much higher, because it does not include children, veterans, or institutionalized individuals. Regardless, this is a staggering number, especially when compared to other diseases that receive extensive media and funding, as can be seen below.
Chronic pain can be defined as a pain that persists longer than 3 months, which is the normal tissue healing time.[v] In addition to this we can include any disruption of the individual’s quality of life caused by the persistence of chronic pain. In a 2012 health survey conducted by the Center for Disease Control (CDC) the top four reported types of chronic pain reported by Americans were: Low back pain (28%), neck pain (14%), headaches / migraines (14%), and facial / jaw pain (5%).[vi] Another survey conducted by the Betty Ford Center found similar results: Low back pain (55.90%), Headaches (33.30%), neck pain (26.30%), and osteoarthritis (21.30%). “Based on the survey, Americans with chronic pain say current treatments don’t work, leading to years of intense suffering, thoughts of suicide and often dependence on medications.”[vii]
Why the Western medical paradigm fails in the Treatment of Chronic Pain?
There are two major problems with the Western model to treat chronic pain. Firstly, and most importantly, Western Doctors don’t have the necessary training in pain – management. In a 2011 study, pain education was assessed in 117 U.S. and Canadian medical schools. Alarmingly, it was found that a large number of U.S. medical schools did not report teaching any pain courses, and an even larger number reported teaching less than 5 hours on the topic of pain. Only 4% of U.S. medical schools reported having any kind of integrated pain courses. In comparison, Canadian medical schools devote twice as many hours as U.S. medical schools for the instruction of pain topics.[viii]
Unlike Western medical training, the curriculum for Eastern physicians includes pain management from the beginning all the way through to graduation. In fact, pain is one of the major focal points in Eastern medicine, and it’s not limited to classroom lectures, but most importantly, includes the clinical setting where we are required to not only treat pain, but listen with empathetic ears to the patient’s story of how their chronic pain has affected their life and daily routines. I stress empathetically, because you’ll find that most Eastern physicians found their way into Alternative medicine after Western medicine had failed them in their own suffering from pain or other disease. All of us found Eastern medicine to be so incredible that we ourselves became practitioners.
Another important characteristic that should be included in a comprehensive pain – management training course is the, how to be a human, aspect of treating pain sufferers. Unfortunately, I’ve heard from many of my patients about extremely poor, and in some cases, utterly deplorable bedside manner in which there is a complete lack of empathy or understanding of the patient’s situation, which in most cases has completely changed their lives, their daily routines, as well as, affecting the lives of their families, friends and co-workers. Another major complaint is the lack of communication from their doctors. This includes not reviewing lab test results with patients; in some cases patients were just sent the results via email with no explanation. In other cases, there was mis-interpretation of results in which immediate action was needed, but not taken. Often there is a lack of communication of pertinent information about the patient’s condition, treatment and prognosis. And finally, the inability of the doctor to merely listen to what their patients are saying.
The second problem with the Western paradigm is that the Western treatment for pain is not a treatment at all, but rather a numbing of the mind by blocking pain signals with pharmacological agents, many of which were never intended to be used as pain medication like anticonvulsants . What happens is that you take these medications and you think you feel better, but in reality the pain is still there; you just don’t perceive it anymore. In fact, you probably have problems perceiving many things, because you’re so drugged – up that you start to lose the ability to function on a daily basis. This type of big pharma pseudo - treatment reaches far beyond just pain cases, this is the protocol for the treatment of all diseases - suppress the symptoms with drugs and ignore discovering what the root of the problem is; and by the way, you have to take these drugs for the rest of your life. Does that sound like a treatment to you? This is why we have a “sick care” system instead of a “health care” system.
This indiscriminate prescribing of painkillers for chronic pain relief has become a grim epidemic in the U.S. that has caused increased rates of overdoses, addiction, depression, and suicide. According to the (CDC), overdose death rates in the U.S. have more than tripled since 1990. In the same report they found that 3 out of 4 prescription drug overdoses are caused by prescription painkillers (opioid and narcotic). In 2008, the number of prescription painkiller overdose deaths surpassed the number of heroin and cocaine overdose deaths combined.[ix] Even worse, due to the addictive nature of opioid painkillers, we are now seeing a rise in the number of heroin users. According to recent research by the U.S. government, half of young heroin users interviewed said they had abused prescription painkillers prior to trying heroin. Two of the most common responses for why they switched to heroin were; 1) heroin was easier to obtain, and 2) heroin was much cheaper.[x]
Major contributors to this epidemic are the doctors/MDs who are senselessly prescribing opioid pain killers without considering the negative consequences their patients will most likely face down the road, like built up tolerances, addiction, further depression, a myriad of other side-effects related to the drugs themselves, and suicidal tendencies; but don’t despair, they have a drug you can take for each and every one of these situations. This raises the question, who’s really benefiting from all these drugs; it certainly isn’t the patient.
Unbeknownst to patients, the vast majority of doctors don’t receive any special training for prescribing these potent pain killers, and even worse, they aren’t required to obtain training. In2010, the Food and Drug Administration (FDA) put together a panel of outside experts to explore the need for specialized training for doctors in the area of prescribing pain-killers. The panel was unanimous in its opinion that doctors should be required to have this training. Despite expert recommendations by their own panel, the FDA decided to make the training voluntary. To make things even more unregulated and unethical, the FDA left the training and course design up to the discretion of the pharmaceutical companies, who then outsourced everything to training companies that know nothing about pharmaceuticals.[xi] This is another blatant example of a government agency sitting in the pocket of big-pharma, and how our “sick care” industry is driven by profits, rather than having the best interest of the patient in mind. Just think for a moment how different (better), things would be if we removed profit from our so – called “health care” system, and focused on disease prevention.
How Does Acupuncture Reduce Chronic Pain
The human body is an amazing organic system that has the ability to self-regulate and heal itself when something is out of balance or injured. Sometimes we impede this process by leading lifestyles that negate health and homeostasis. Acupuncture is a simple and marvelous tool that is used to restore balance by both inhibiting and sending signals through the vast network of the nervous system, which enables a wide array of therapeutic effects both locally and systemically.
For the treatment of chronic pain it’s more common to use electro-acupuncture (EA), because it has a stronger analgesic effect compared to regular acupuncture. EA is acupuncture, but with the addition of a low frequency (20Hz), electrical current that is passed through a pair of selected needles. This constant and consistent stimulation produces rapid therapeutic effects, which usually take longer to achieve with manual stimulation (twirling the needle between the fingers). Many studies have demonstrated the effectiveness of EA in the treatment of chronic pain through the release of opioids in the brain and spinal cord, as well as, the stimulation of neurotransmitters; both of which reduce pain.[xii] [xiii] Data confirms the following effects elicited by EA treatment for pain:
An interesting study out of Germany used functional magnetic resonance imaging (fMRI) with and without acupuncture to see which parts of the brain were activated during pain stimulation. Scientists initiated a pain stimulus without acupuncture to volunteers to record the areas of the brain that were activated. Researchers found that there was a significant reduction in most of the areas of the brain that perceive and process pain, which led to the conclusion that acupuncture is an effective therapy for pain. The study showed that acupuncture inhibits the incoming signals to the brain much like opioid drugs do, and it also alters the patient’s perception of pain by producing a placebo-like analgesic response in the brain.
Evidence Based Acupuncture is the Answer to the Chronic Pain Epidemic
There’s a reason why acupuncture has been used successfully for over 2,000 years for the treatment of pain and other conditions, and continues to become more popular today in our modern society - because it works, and it works without the need of drugs. Not until the last couple of decades has the West begun to understand the mechanism behind this non-invasive natural treatment, as well as, its clinical importance as a drug-free alternative for the treatment of chronic pain. In one study, when acupuncture was compared to conventional primary care for the treatment of non-specific chronic low back pain, it was determined that acupuncture treatments are safe, more efficacious than conventional care, provided longer lasting results, and a more cost-effective intervention for reducing chronic pain.[xx] Similar results have also been found in studies pertaining to headaches / migraines[xxi], neck pain[xxii], osteoarthritis pain[xxiii], etc. In a meta-analysis of patient data conducted by the Memorial Sloan – Kettering Cancer Institute, it was shown that acupuncture was an effective treatment for the following pain conditions: back and neck pain, osteoarthritis, chronic headache, and shoulder pain. It also concluded that acupuncture was an acceptable alternative for the treatment of chronic pain.[xxiv]
The Final Verdict
America’s chronic pain epidemic will only get worse, with increased painkiller and heroin addictions, and higher rates of depression and suicide. This is the only future for people who choose to remain within the “sick care” system, which is unethically encouraged by big-pharma, insurance companies, doctors and MD's, and the U.S. government, all of whom seek to keep Americans on drugs for the rest of their lives. This system of medicine, which is driven by profit and strongly opposed to disease prevention and treatment, will continue to prescribe dangerous drugs that only have the sole purpose of suppressing symptoms, instead of upholding the Hippocratic Oath and solving the root cause of chronic pain.
It’s time for chronic pain sufferers to realize that we already have an evidence based solution for pain, one that has been utilized for thousands of years. It’s been proven to more efficacious, more cost-effective and safer. It’s time to end your pain America! So why aren't we using it?
Seek out your local licensed & board certified acupuncturist today, so you can have a healthier and pain free tomorrow.
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[i] Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press, 2011.
[ii] Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015;131:e29-322.
[iii] American Cancer Society. Cancer Facts & Figures 2015. Atlanta: American Cancer Society; 2015.
[iv] Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: US Department of Health and Human Services; 2014.
[v] Carr, Daniel B., MD, ed. "How Prevalent Is Chronic Pain?" Pain: Clinical Updates - IASP Volume XI, No. 2 (June 2003): 1. Pain: Clinical Updates - IASP. International Association for the Study of Pain. Web. 10 Mar. 2015.
[vi] Blackwell DL, Lucas JW, Clarke TC. Summary health statistics for U.S. adults: National Health Interview Survey, 2012. National Center for Health Statistics. Vital Health Stat 10(260). 2014.
[vii] "Hazelden Betty Ford Pain And Addiction Report." Chronic Pain in America: Consequences, Addiction and Treatment (n.d.): n. pag. Betty Ford Center. Betty Ford Center, 14 Oct. 2014. Web. 2 Mar. 2015.
[viii] Mezei L1, Murinson BB; Johns Hopkins Pain Curriculum Development Team. Pain education in North American medical schools. J Pain. 2011 Dec;12(12):1199-208. doi: 10.1016/j.jpain.2011.06.006. Epub 2011 Sep 25.
[ix] CDC. Vital Signs: Overdoses of Prescription Opioid Pain Relievers—United States, 1999-2008. MMWR 2011; 60: 1-6.
[x] "Heroin." How Is Heroin Linked to Prescription Drug Abuse? National Institute on Drug Abuse, Nov. 2014. Web. 01 Apr. 2015.
[xi] Meier, Barry. "F.D.A. Won’t Order Doctors to Get Pain-Drug Training." The New York Times. N.p., 9 July 2012. Web. 10 Mar. 2015.
[xii] Shankar N, Thakur M, Tandon OP, Saxena AK, Arora S, Bhattacharya N. Autonomic status and pain profile in patients of chronic low back pain and following electro acupuncture therapy: a randomized control trial. Indian J Physiol Pharmacol. 2011 Jan-Mar;55(1):25-36.
[xiii] Zhang R, Lao L, Ren K, Berman BM. Mechanisms of acupuncture-electroacupuncture on persistent pain. Anesthesiology. 2014 Feb;120(2):482-503. doi: 10.1097/ALN.0000000000000101.
[xiv] Lee HJ, Lee JH, Lee EO, Lee HJ, Kim KH, Lee KS, Lee CH, Nam DW, Kim SH, Lee HJ, Ahn KS. Substance P and beta endorphin mediate electroacupuncture induced analgesic activity in mouse cancer pain model. Acupunct Electrother Res. 2009;34(1-2):27-40.
[xv] Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol. 2008 Aug;85(4):355-75. doi: 10.1016/j.pneurobio.2008.05.004. Epub 2008 Jun 5.
[xvi] Kim HW, Roh DH, Yoon SY, Kang SY, Kwon YB, Han HJ, Lee HJ, Choi SM, Ryu YH, Beitz AJ, Lee JH. The anti-inflammatory effects of low- and high-frequency electroacupuncture are mediated by peripheral opioids in a mouse air pouch inflammation model. J Altern Complement Med. 2006 Jan-Feb;12(1):39-44.
[xvii] Hyun-Woo Kima, Suk-Yun Kanga, Seo-Yeon Yoona, Dae-Hyun Roha, Young-Bae Kwonb, Ho-Jae Hanc, Hye-Jung Leed, Alvin J. Beitze, Jang-Hern Leea. Low-frequency electroacupuncture suppresses zymosan-induced peripheral inflammation via activation of sympathetic post-ganglionic neurons. Brain Res. 2007 May 7;1148:69-75. Epub 2007 Feb 24.
[xviii] Shin Takayama, Masashi Watanabe, Hiroko Kusuyama, Satoru Nagase, Takashi Seki, Toru Nakazawa, and Nobuo Yaegashi . Evaluation of the Effects of Acupuncture on Blood Flow in Humans with Ultrasound Color Doppler Imaging. Evid Based Complement Alternat Med. 2012; 2012: 513638.
[xix] Qian-Qian Li, Guang-Xia Shi, Qian Xu, Jing Wang, Cun-Zhi Liu,* and Lin-Peng Wang. Acupuncture Effect and Central Autonomic Regulation. Evid Based Complement Alternat Med. 2013; 2013: 267959.
Published online 2013 May 26.
[xx] Thomas KJ1, MacPherson H, Ratcliffe J, Thorpe L, Brazier J, Campbell M, Fitter M, Roman M, Walters S, Nicholl JP. Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain. Health Technol Assess. 2005 Aug;9(32):iii-iv, ix-x, 1-109.
[xxi] Vickers AJ1, Rees RW, Zollman CE, McCarney R, Smith CM, Ellis N, Fisher P, Van Haselen R, Wonderling D, Grieve R. Acupuncture of chronic headache disorders in primary care: randomised controlled trial and economic analysis. Health Technol Assess. 2004 Nov;8(48):iii, 1-35.
[xxii] Willich SN1, Reinhold T, Selim D, Jena S, Brinkhaus B, Witt CM. Cost-effectiveness of acupuncture treatment in patients with chronic neck pain. Pain. 2006 Nov;125(1-2):107-13. Epub 2006 Jul 13.
[xxiii] Reinhold T1, Witt CM, Jena S, Brinkhaus B, Willich SN. Quality of life and cost-effectiveness of acupuncture treatment in patients with osteoarthritis pain.
[xxiv] Vickers AJ1, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, Sherman KJ, Witt CM, Linde K; Acupuncture Trialists' Collaboration. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012 Oct 22;172(19):1444-53. doi: 10.1001/archinternmed.2012.3654.
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