Acupuncture for the Treatment of Musculoskeletal Injury and Pain
Musculoskeletal conditions comprise over 150 diseases and syndromes, which are usually associated with pain of varying severity. They can broadly be categorised as joint diseases, physical disability, spinal disorders, and conditions resulting from trauma. Common areas affected include the hands, wrists, elbows, neck, shoulders, lower back, hips, ankles and feet (European Commission). It is the leading cause of temporary work disability amongst Ireland’s working age population and costs Ireland €750m each year and 7 million days in absenteeism (FFW, 2013).
WHAT CAN TRADITIONAL ACUPUNCTURE DO FOR MUSCULOSKELETAL CONDITIONS AND HOW DOES IT WORK?
Traditional Chinese Acupuncture treatments are based on an individual diagnosis and work by treating the underlying root cause of any condition as well as the symptoms. Acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules and the resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being. A 2010 study, using fMRI to monitor the effects of several classical acupoints on the human brain, indicated that acupuncture modulates the limbic network, an important intrinsic regulatory system of the human brain (Hui et al., 2010).
EVIDENCE FOR ACUPUNCTURE
Below is a sample of the growing body of research verifying the effectiveness of acupuncture in the treatment of many musculoskeletal conditions. Research trials often compare “real-acupuncture” to “sham-acupuncture” which potentially underestimates the effect of ‘real’ acupuncture as ‘sham’ interventions are not inert placebos (Lundeberg et al., 2011).
Fibromyalgia, Low Back Pain & Osteoarthritis
According to the 2013 report from Arthritis Research UK, acupuncture is the most effective form of complementary therapy for treating osteoarthritis, low back pain and fibromyalgia (Arthritis Research, 2013).
Frozen Shoulder
(adhesive capsulitis), a common, painful and sometimes disabling condition that can last for months or years. The pragmatic German Randomised Acupuncture Trial for chronic shoulder pain (GRASP) showed that Chinese acupuncture is more effective than conventional standard therapy with NSAIDs and physiotherapy(Molsberger et al., 2010).
Neck pain
In a study of 517 patients with neck pain of a median duration of 6 years, acupuncture treatment led to significant reductions in neck pain and associated disability compared with usual care at 12 months (MacPherson et al., 2013).
Knee pain
In a study to compare the effectiveness of acupuncture with other relevant physical treatments for alleviating pain due to knee osteoarthritis, acupuncture treatment was found to be significantly better than standard care (Corbett et al., 2013).
Carpal Tunnel Syndrome
Affects 1 in 10 people and involves potentially disabling sensory and/or motor symptoms in the hand. Researchers in a 2010 RCT concluded that acupuncture was as effective as orthodox treatment of night splinting in terms of overall symptoms and function, and superior to it for pain control(Kumnerddee & Kaewtong, 2010).
Tennis elbow
A systematic review of RCTs of acupuncture and moxabustion for lateral elbow pain showed that the acupuncture group had a significantly higher cured rate than conventional therapy, including prednisolone injection, triamcinolone acetonide, lidocaine injection and oral administration of meloxicam tablets (Gadau et al., 2014).
Plantar fasciitis
Researchers concluded that the results of a 2011 RCT showed that acupuncture can provide pain relief to patient with plantar fasciitis (Zhang et al., 2011).
Shin splints (tibial stress syndrome) In a 2002 clinical study of 40 athletes, those in the acupuncture groups experienced greater pain relief and took significantly fewer doses of NSAIDs during the course of the study than athletes in the sports medicine only group (Callison, 2002).
Patellofemoral pain syndrome
A systematic review of the quality of randomized controlled trials for patellofemoral pain syndrome concluded that acupuncture was effective in decreasing pain and improving function in patients with patellofemoral pain syndrome (Bizzini et al., 2003).
Soft tissue disease
In a 1989 study, 360 observations were made on 120 cases of soft tissue injury divided into groups. The researchers concluded that acupuncture treatment on soft tissue disease based on TCM syndrome differentiation theory is thus shown to be effective (Yuan et al., 1989).
Achilles Tendinopathy
Researchers found that compared with exercise therapy, acupuncture can produce significant and more rapid improvements in pain and activity levels in patients with chronic Achilles Tendinopathy (Zhang et al., 2013).
Performance & Recovery
A systematic review supports the use of acupuncture as a means to enhance exercise performance and post-exercise recovery (Urroz et al., 2013).
THE ROLE OF PROFESSIONAL ACUPUNCTURE IN MAINSTREAM HEALTHCARE SYSTEMS
Acupuncture as practiced by Professional Traditional Acupuncturists is widely used in mainstream hospitals throughout the World, including the Whittington Hospital in London which has a dedicated Pain Clinic run entirely by TCM practitioners. The therapeutic benefits of acupuncture have been embraced internationally due to its proven effectiveness not only in respect of the management of chronic and acute conditions but also in the treatment of their underlying causes. It is now the largest drug-free healthcare therapy in the World whilst being compatible with and therefore capable of being used alongside Western (Orthodox) Medicine.
In Ireland acupuncture is becoming increasingly acknowledged within mainstream healthcare as a treatment option for many conditions and is included in many private health insurance plans. This potential of acupuncture to deliver timely, cost effective, safe and clinically effective management of a range of conditions, including pain and injury, has yet to be fully exploited and referrals to acupuncture clinics are likely to become more commonplace as happens in other countries.
TRADITIONAL ACUPUNCTURISTS IN IRELAND
Traditional Acupuncturists are trained in the authentic medical tradition of Chinese Medicine which is a sophisticated and complete medical system of diagnosis and treatments that has evolved over more than 3000 years. Acupuncture is only one of several treatment modalities used in Chinese Medicine and is mainly practised in Ireland by traditionally trained practitioners. Whilst acupuncture has now become popular with other professions as an adjunct treatment, it’s use within the full traditional context of Chinese Medicine remains by far the most effective and has a broader scope of applications.
The Acupuncture Foundation Professional Association (AFPA) is the leading independent Professional Association of Acupuncturists and Chinese Medical Practitioners in Ireland. Established in 1987, it is the oldest and largest organisation with responsibility for the regulation and maintenance of a Register of Acupuncturists who work within the guidelines set out by the Department of Health. Our members are bound by a Code of Ethics and Practice which is strictly enforced by the AFPA. The AFPA is also a longstanding member of the European Traditional Chinese Medicine Association (ETCMA) and works in collaboration with 24 other organisations representing over 14,000 practitioners.
QUALITY AND SAFETY
Acupuncture is considered very safe in the hands of well-trained practitioners. Ensure that you receive the highest standard and most effective acupuncture treatment by attending a Registered Acupuncturist who is suitably qualified with a minimum of three years training in this specialised therapy. In Ireland practitioners should be a registered member of a Professional Association such as the AFPA which oversees excellence in training, safe practice and professional conduct. Find a registered professional acupuncturist here.
BIBLIOGRAPHY
Arthritis Research (2013) Complementary and alternative therapies report. Available from: <http://www.arthritisresearchuk.org/shop/products/publications/patient-information/living-with-arthritis/cat-report.aspx#> [Accessed 12 February 2016].
Bizzini, M., Childs, J.D., Piva, S.R. & Delitto, A. (2003) Systematic review of the quality of randomized controlled trials for patellofemoral pain syndrome. The Journal of orthopaedic and sports physical therapy, 33 (1), pp.4–20.
Callison, M. (2002) Clinical study. Acupuncture and tibial stress syndrome (shin splints). Journal of Chinese Medicine.
Corbett, M.S., Rice, S.J.C., Madurasinghe, V., Slack, R., Fayter, D.A., Harden, M., Sutton, A.J., Macpherson, H. & Woolacott, N.F. (2013) Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society, 21 (9), pp.1290–8.
European Commission (2015) Musculoskeletal conditions [Internet]. Available from: <http://ec.europa.eu/health/major_chronic_diseases/diseases/musculoskeletal/index_en.htm> [Accessed 13 February 2016].
FFW (2013) Fit For Work Ireland Position Paper.
Gadau, M., Yeung, W.-F., Liu, H., Zaslawski, C., Tan, Y.-S., Wang, F.-C., Bangrazi, S., Chung, K.-F., Bian, Z.-X. & Zhang, S.-P. (2014) Acupuncture and moxibustion for lateral elbow pain: a systematic review of randomized controlled trials. BMC complementary and alternative medicine, 14, p.136.
Hui, K.K.S., Napadow, V., Liu, J., Li, M., Marina, O., Nixon, E.E., Claunch, J.D., LaCount, L., Sporko, T. & Kwong, K.K. (2010) Monitoring acupuncture effects on human brain by FMRI. Journal of visualized experiments : JoVE, (38).
Kumnerddee, W. & Kaewtong, A. (2010) Efficacy of acupuncture versus night splinting for carpal tunnel syndrome: a randomized clinical trial. Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 93 (12), pp.1463–9.
Lundeberg, T., Lund, I., Sing, A. & Näslund, J. (2011) Is placebo acupuncture what it is intended to be? Evidence-based complementary and alternative medicine : eCAM, 2011, p.932407.
MacPherson, H., Tilbrook, H.E., Richmond, S.J., Atkin, K., Ballard, K., Bland, M., Eldred, J., Essex, H.N., Hopton, A., Lansdown, H., Muhammad, U., Parrott, S., Torgerson, D., Wenham, A., Woodman, J. & Watt, I. (2013) Alexander Technique Lessons, Acupuncture Sessions or usual care for patients with chronic neck pain (ATLAS): study protocol for a randomised controlled trial. Trials, 14, p.209.
Molsberger, A.F., Schneider, T., Gotthardt, H. & Drabik, A. (2010) German Randomized Acupuncture Trial for chronic shoulder pain (GRASP)- A pragmatic, controlled, patient-blinded, multi-centre trial in an outpatient care environment. Pain, 151, pp.146–154.
Urroz, P., Colagiuri, B., Smith, C.A. & Cheema, B.S. (2013) Effect of Acute Acupuncture Treatment on Exercise Performance and Postexercise. Journal of Alternative and Complementary Medicine, 19 (1), pp.9–16.
Yuan, C., Xing, J. & Yan, C. (1989) Observations on clinical therapeutic effect in treating soft tissue injuries. Journal Of Traditional Chinese Medicine, 9 (1), pp.40–44.
Zhang, B., Zhong, L., Xu, S., Jiang, H. & Shen, J. (2013) Acupuncture for chronic Achilles tendnopathy: a randomized controlled study. Chinese Journal Of Integrative Medicine, 19 (12), pp.900–904.
Zhang, S.P., Yip, T.-P. & Li, Q.-S. (2011) Acupuncture treatment for plantar fasciitis: a randomized controlled trial with six months follow-up. Evidence-based complementary and alternative medicine : eCAM, 2011, p.154108.
