Acupuncture and Massage May Be Part of Pain Management Plan in Patients with Advanced Cancer

PainRelief.com Interview with:
Jun J. Mao, MD, MSCE
Chief, Integrative Medicine Service
Laurance S. Rockefeller Chair in Integrative Medicine
Memorial Sloan Kettering Cancer Center

PainRelief.com: What is the background for this study?

Response: Most of the pain intervention trials focused on cancer survivors who completed treatment or patients in hospice care, little is know how these treatments work in patients living with advanced cancer. With the improvement in cancer treatment, many people are now living with advanced cancer but suffer from pain from their cancer or treatment.

Since acupuncture and massage have been found effective to manage pain in other populations, we designed this study to compare the effectiveness of these two interventions for musculoskeletal pain among patients living with advanced cancer. We hoped these results will aid patients and their doctors to make informed decision in pain treatment.

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Acupuncture for Pain Relief: Insurance Coverage Increasing But Most Still Self Pay

PainRelief.com Interview with:
Molly Candon, PhD
Research Assistant Professor, Center for Mental Health, Department of Psychiatry
Assistant Professor, Department of Health Care Management
Director, Associate Fellows Program, Leonard Davis Institute of Health Economics
Perelman School of Medicine and the Wharton School
University of Pennsylvania

Molly Candon, PhD Research Assistant Professor, Center for Mental Health, Department of Psychiatry Assistant Professor, Department of Health Care Management Director, Associate Fellows Program, Leonard Davis Institute of Health Economics Perelman School of Medicine and the Wharton School University of Pennsylvania
Dr. Candon

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Insurance design for pain care, including whether treatments are covered and how generously they are covered, is an important element of access and adherence. Acupuncture therapy is a safe and evidence-based treatment for numerous pain conditions, and our team was curious if acupuncture coverage has changed in recent years given the need for non-opioid treatments during the ongoing opioid epidemic. 

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Acupuncture for Pain Relief from Chronic Prostatitis and Chronic Pelvic Pain Syndrome

PainRelief.com Interview with:

Zhishun Liu, MD, PhD
Guang’anmen Hospital
China Academy of Chinese Medical Sciences
Beijing, China

acupuncture

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Pharmacologic therapy has so far failed to reveal universal benefits in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS); the evidence for acupuncture is limited, although it is also recommended in current guidelines.

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Auricular Acupuncture for Musculoskeletal Pain Relief in Cancer Patients

MedicalResearch.com Interview with:

Jun JMaoMD, MSCE
Integrative Medicine Service, Department of Medicine
Memorial Sloan Kettering Cancer Center
New York, New York

Dr. Jun J. Mao

MedicalResearch.com:  What is the background for this study?

Response: The opioid crisis has fueled growing interest in non-pharmacological pain management options. Last year, Medicare approved insurance coverage of acupuncture for chronic low back pain. Despite this progress, many cancer survivors continue to struggle with chronic pain. 

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Electro-Acupuncture Can Provide Pain Relief from Chronic Low Back Pain

PainRelief.com Interview with:

Jiang-Ti Kong, MD, Division of Pain Medicine
Department of Anesthesiology, Perioperative and Pain Medicine
Stanford University School of Medicine
Palo Alto, CA

PainRelief.com:  What is the background for this study?

Response: Chronic low back pain is the most common chronic pain condition. Its treatment can be challenging, particularly given the side effects from conventional treatments. These include surgical complications and medication side effects, such as opioid dependence and kidney/liver damage. Acupuncture is receiving increasing attention as an alternative treatment for chronic low back pain. However, multiple large studies showed similar effect sizes between real acupuncture and sham (control) acupuncture. Interestingly, most of these studies involve the use of manual acupuncture, while pre-clinical studies suggest the use of electro-acupuncture may lead to greater analgesia than control. Few have formally studied the clinical effect of electro-acupuncture in a randomized, controlled setting. A major objective of our study was to investigate the clinical effect of electro-acupuncture relative to sham control in a randomized, participant- and assessor-blinded, clinical trial.

Acupuncture needle

Equally importantly, we were interested in exploring predictors of clinical response to electro-acupuncture, because, in general, about 40-60% of individuals treated with acupuncture experience clinically significant improvement. It would be helpful to identify responders to acupuncture before treatment initiation. We explored potential predictors of clinical response to electro-acupuncture by performing univariate, treatment heterogeneity and multivariate analysis between baseline participant characteristics and clinical outcome, defined as either pain reduction or improvement in function.

Can CBD and Cannabis Provide Pain Relief in Fibromyalgia?

PainRelief.com Interview with:
Amnon A. Berger, MD, PhD
MD/PhD Program 2006-2017
The Hebrew University Hadassah Medical School
Jerusalem, Israel
Resident Physician (CA-1/PGY-2) and Loring Scholar
Department of Anesthesiology, Critical Care and Pain Medicine
Beth Israel Deaconess Medical Center, Boston, MA

Dr. Berger

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Fibromyalgia is a common disorder of chronic widespread pain. It has been estimated to affect 2-4% of the general population, though that number is likely an underestimate of the actual incidence. Outside of chronic pain, it also contributes to morbidity and disability because it affects sleep, causes cognitive impairment and psychiatric perturbations. Fibromyalgia is difficult to diagnose and even more difficult to treat.

Because the underlying causes – the etiology and pathophysiology at the base of this condition – are still largely unknown, it is harder to tailor specific treatments. There is evidence to support several modes of treatment, but truly high-level evidence exists only for physical exercise. Effective treatment depends on long term commitment and a multimodal approach by a multidisciplinary team.

Recently, with the rise of use in cannabis and CBD, both for medical and recreational use, evidence has emerged to support its use in fibromyalgia. While most of the evidence is not clear cut and not high enough evidence to support cannabis use, the evidence is overall positive and cannabis derivatives may be an effective choice as part of a multimodal treatment plan.

Traditional and Battlefield Acupuncture Provide Post-Op Pain Relief and Reduced Need for Opioids

PainRelief.com Interview with:

  • Brinda Krish, D.O., lead author of the study and an anesthesiology resident at Detroit Medical Center.
  • Padmavathi Patel, M.D., principal investigator of the study and Medical Director, Northstar Anesthesia at John D. Dingell Veteran Hospital.

PainRelief.com:  What is the background for this study?  What are the main findings?

Dr. Padmavathi Patel: Pain is a major contributor to health care costs and a common cause of long-term disability (about  $61.2 billion/year) in lost productivity due to pain.

acupuncture

76.2 million Americans (one in four) have suffered from pain that lasts longer than 24 hours (2013).

Numerous literature such as:

1. “Use of prescription opioids in the treatment of pain has increased notably over recent decades.”

2. “Rates of death from prescribed opioids increased four fold between 2000 and 2014.”

3. “16,651 opioid related deaths in 2010.”

4. “The problem of opioid overuse and dependence is seen in the military as well as in civilian.”

-Opioid-related side effects could lead to a delay in recovery.
-Pain control is more challenging for military population.
-More extensive injuries and greater pain severity is seen in survivors of combat- related blast injuries compared to those of non-blast civilians and also they require larger opioid doses.
-Pain is a very common patient complaint, both in veteran and non-veteran populations.
-Among the 5.7 million unique patients seen annually with in the Department of Veterans Affairs (DVA), more than half of these patients experience chronic pain.

In 2017, The DVA and the United States Department of Defense (DoD) published an updated guidelines on opioid therapy for chronic pain that strongly recommends against initiation of long-term opioid use and recommends alternatives, including non-pharmacologic therapy, such as Acupuncture, which has been shown to be effective for treating a variety of painful conditions.

Acupuncture techniques have been in existence for centuries, with roots tied to Eastern Asia. Traditional acupuncture involves the insertion of very thin needles at specific trigger points around the body to relieve pain. Battlefield acupuncture (BFA), developed by a U.S. Air Force doctor uses needles that are inserted at various trigger points in the ear. In 2013, $5.4 million was awarded to the Departments of Defense and Veterans Affairs to teach BFA to healthcare providers in both the military and the Department of Veterans Affairs and assess it.  In light of the opioid epidemic, there is a strong need to decrease perioperative opioid use. Opioid use due to postoperative pain along with perioperative anxiety has been linked to increased length of hospital stay, increased morbidity and mortality, and ultimately higher healthcare costs.

Battlefield acupuncture was introduced into Veterans Health Administration (VHA) in the last few years and in VHA, clinicians of various disciplines (MDs, DOs, PAs, nurse-practitioners), can currently obtain clinical privilege to provide it.

I received the Battlefield acupuncture training at John D. Dingell VA medical Center, Detroit and I was surprised with the outcomes of chronic pain patients. As an anesthesiologist I know pain after the surgery is common, often severe and largely unnecessary. I discussed these concerns with the surgeons and created the protocol to use BFA for general surgical patients and traditional acupuncture for hip replacement patients as an adjuvant to the standard protocol for acute post-surgical pain control.

Effective relief of postoperative pain is vital. Such pain probably prolongs hospital stay, as it can affect all the organ systems with side effects. Post op pain remains grossly under treated, with up to 70% of patients reporting moderate to severe pain following surgery.

Multimodal pain control not only can result in earlier discharge from hospital, but it may also reduce the onset of chronic pain syndromes.

2 studies performed TA (n=21), Controls given sham acupuncture (n=21).  BFA (n=28), Controls given sham acupuncture (n=36). Measured variables included post-operative opioid requirements, postoperative pain, the incidence of PONV, and patient satisfaction scores

Key conclusions use of Battlefield acupuncture and Traditional acupuncture reduced post-operative opioid requirements, post-operative pain scores (pain intensity) and increased patient satisfaction scores.  BFA also reduced PONV in patients.  

What is the Biological Basis of Acupuncture for Systemic Inflammation Modulation?

PainRelief.com Interview with:
QIUFU MA, PhD
Professor, Neurobiology, Cancer Biology
Harvard Medical School
Dana-Farber Cancer Institute

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: This study aimed to understand the biological basis behind acupuncture practice. Modern randomized clinical trials have demonstrated the efficacy of acupuncture practice in treating certain human diseases, such as gastrointestinal disorders and chronic pain, but the underlying biological basis still poorly understood.

Our hypothesis is that acupuncture can drive the somatosensory autonomic pathways to modulate body physiology. A key innovation of this study is the development of new genetic tools to manipulate different autonomic nervous pathways, and we then used the severe systemic inflammation (cytokine storms) induced by bacterial endotoxins as the experimental model.

We found that electroacupuncture stimulation (ES) can drive distinct autonomic pathways in acupoint- and stimulation-intensity-dependent manners. Low intensity ES at hindlimb regions drives the vagal-adrenal axis, producing anti-inflammatory effects that depend on adrenal chromaffin cells. High intensity ES at the abdomen activates splenic noradrenergic neurons via the spinal-sympathetic axis, and this activation produces either anti- or pro-inflammatory effects, dependent on adrenergic receptor profiles under different diseases states

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Acupuncture for Migraine Pain Relief

PainRelief.com Interview with:

Prof. Wei Wang
Department of Neurology,
Tongji Hospital, Tongji Medical College,
Huazhong University of Science and Technology,
Wuhan, Hubei, P.R. China

acupuncture

PainRelief.com:  What is the background for this study?

Response: The burden of migraine is substantial, resulting in considerable economic and social losses. The latest Global Burden of Disease Study showed that 1.25 billion people had migraine in 2017. A significant number of patients are still not responding well to drug therapy, or cannot tolerate the adverse effects of drugs, or have contraindications, which can lead to low medication compliance, headache chronification and acute medication overuse. Prophylactic drugs should be recommended for migraineurs who have at least four headache days per month, but only 13% of patients reported current use of preventive drugs. Besides, ineffectiveness of and/or contraindications to migraine medication affect 10-15% of people with migraine. Hence, a need exists to investigate non-drug interventions.

Previous studies suggest that acupuncture works particularly well on a range of pain disorders. However, clinical evidence for the benefit of manual acupuncture for migraine prophylaxis remains scarce. Appropriate placebo control settings and successful blinding are two critical elements in addressing this challenge. Sham acupuncture involving penetrating needles should be avoided in clinical trials. Previous acupuncture research has often used penetrating sham acupuncture, involving needling non-acupuncture points, needling irrelevant acupuncture points, or superficial needling. However, whether the needle is inserted into an acupuncture point or a non-acupuncture point, it could produce a physiological effect. Comparisons between true acupuncture and sham acupuncture might also be biased by unsuccessful blinding. To ensure an inert placebo control and successful blinding, we recruited acupuncture-naive patients, using non-penetrating sham acupuncture at heterosegmental non-acupuncture points as the control, and designed the same procedures to perform the same rituals as much as possible in the manual and sham acupuncture groups.

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Acupuncture for Chronic Musculoskeletal Pain Relief: A Review of Randomized Trial

PainRelief.com Interview with:
Chenchen Wang MD, MSc
Professor of Medicine
Tufts University School of Medicine
 Director, Center For Complementary And Integrative Medicine                                             
Division of Rheumatology
Tufts Medical Center, Boston, MA

Dr. Chenchen Wang
Dr. Chenchen Wang

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Chronic Musculoskeletal Pain is a complex disorder without effective treatment Acupuncture, originating in China more than 3,000 years ago, is one of the most popular sensory stimulation therapies. However, despite the fact that acupuncture is widely used for pain relief in a number of conditions including severe knee osteoarthritis, acute postoperative pain, musculoskeletal disorders, evidence of the effect of Chronic Musculoskeletal Pain relief is scarce.


Our study was to determine the efficacy of acupuncture for pain relief in this field.

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