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Acupuncture and Chronic Pain Management

Posted on: 04/26/2007
Many people who experience chronic pain search for alternative methods of pain relief. In this article, researchers review four studies that investigated the effectiveness of acupuncture among people with migraines, tension-type headaches, chronic lower back pain, or osteoarthritis of the knee.

At the start of each study, patients were asked about their ideas of acupuncture and its effectiveness. Many said that they were confident that the acupuncture would help relieve their pain. However, patients in headache groups tended to have a less optimistic view of acupuncture than did those in the back pain or osteoarthritis groups. Researchers believed that those patients who had high expectations of the treatment would have better outcomes than would those who had doubts regarding the treatment.

In three of the studies, the patients were assigned to either an acupuncture group or a superficial needling group to mimic the acupuncture; the patients were blinded as to which group they were in. The migraine study also had the two groups and a third control group. Patients in all of the study groups, other than the control group, received either acupuncture or minimal needling for 30 minutes, once a week for 12 weeks. The patients were allowed to take pain relievers for acute pain if needed.

Overall, 864 patients participated and those patients who had been confident that the acupuncture would provide relief reported significantly better pain relief than did those who had not been confident. The odds ratios for response between patients who thought acupuncture was effective and those who did not share this belief was 1.67 (95% confidence interval 1.20-2.32). For personal expectations and confidence after the third session, odds ratios were 2.03 (1.26-3.26) and 2.35 (1.68-3.30), respectively. This was true during the study time and at follow-up four to six months later, and held true for both the acupuncture and the minimal needling groups. The researchers found that the patients in the osteoarthritis and the lower back pain groups reported more success from the acupuncture than did those in the headache groups.

Although there are still many questions, such as whether patients who had higher expectations regarding acupuncture had as much pain as those who didn't, the researchers conclude that these studies show that there is an effect from patient expectations regarding pain relief for chronic pain. More studies need to be undertaken in order to find ways to measure patient expectations and the researchers recommend that in future studies, investigators ask about expectations as part of their study protocols.

References:
Klaus Linde, MD, et al. The Impact of Patient Expectations on Outcomes in Four Randomized Controlled Trials of Acupuncture in Patients with Chronic Pain. In Pain. 2007. Vol. 128. Issue 3. Pp 264-271.

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