Medical Pain Education
Acupuncture for Pain and Autonomic Dysfunction:
Simon Strauss MBBS, Dip. Acupuncture,
Nanjing 1978. Four
retrospective surveys were carried out to assess the patient's
opinion of acupuncture efficacy for a range of pain and
autonomic dysfunction conditions. The acupuncture treatment
method used was based on the techniques taught at the first
WHO sponsored course for Western medical practitioners held in
Nanjing, China, at the Nanjing School of Traditional Chinese
Medicine in 1978. Each survey was carried out at different
lengths of follow up. The first group of
124 patients were all referred and all followed up by
telephone after about 6 weeks. The method of
acupuncture that was usually used for chronic pain conditions
is best described as the near-and-far method. This method
utilises both local/segmental and supraspinal reflexes to
promote muscle relaxation, increase tissue perfusion and
remove trigger points. It is a rehabilitation technique not
designed to provide analgesia as a primary objective.
Electrical stimulation of the needles was rarely done.
Attention was paid to precise point location, and the
Bu/Tonifying/warming needling technique, where the needle is
inserted painlessly and gently twirled until needle grasp (De
Qi) is obtained and then left in situ for 20 minutes, was used
most frequently. Moxibustion was used when indicated. Cupping,
aquapuncture, laser and osteopuncture were not
used. METHOD
Is your
pain: More
frequent? More
severe? Has your range
of movement: Improved? Remains
unchanged? The above questions
were asked about each of the pain conditions treated. COMMENT RESULTS Survey
Comparisons Survey Number of
responders Length of follow
up Method % survey
responders Acupuncture of
benefit 1. 124 6
Weeks Telephone 100% Yes!
84% 2. 478 6
Months Mail 75% Yes!
88% 3. 1146 1
Year Mail 55% Yes!
87% 4. 128 1 to 4
Years Mail 35% Yes!
85% Table 1
(Survey 1) Effectiveness of Acupuncture Therapy
in Chronic Pain Conditions
Condition Acupuncture
Frequency of
Pain Severity of
Pain Range of
Number Pain
Duration Yes Less None- much
less Less None- much
less Impro-ved Very much
Improved Cervical Brachial
Syndrome 90% 35% 45% 32% 57% 25% 57% 9.4 6.1 Multiple Site
Backache 82% 76% 11% 35% 41% 35% 41% 12.4 6.9 Sciatica 86% 35% 28% 28% 42% 14% 28% 11.5 3.4 Low Back Pain 76% 54% 15% 23% 52% 15% 30% 8.8 9.6 Headache 70% 30% 40% 40% 40% - - 9.7 10 Migraine 86% 42% 42% 28% 57% - - 8.5 17 Painful
Shoulder 100% 60% 40% 50% 50% 50% 50% 10.8 3.4 CBS and Frozen
Shoulder 75% 60% 40% 60% 40% 60% 40% 10 6.2 Tennis Elbow 60% - 40% - 40% 40% - 7.8 1.8 CBS and Tennis
Elbow 100% 50% - - 50% 50% 50% 8.5 5 Knee Pain 75% 30% 50% 30% 50% - 50% 7.5 4 Total 84% 42% 35% 29% 50% 9.8 7
Acupuncture of benefit? 427 Yes. 51
No Sleep Disturbance
233 Improved 50% Table 2 Symptom
Profile with Patients' Opinion Where
greatly helped = (much less frequent - no pain,) + (very much
less severe - no pain)/2.
Symptom Number
with. Greatly
helped Helped Back Pain 136 56.5% 30.5% Headache 100 63% 22% Anxiety 94 67% 22% Neck & Arm
Pain 72 73.5% 14% Knee Pain 66 54.5% 32% Sciatica Pain 58 56% 30% Neck Pain 56 59.5% 26.5% Hip Pain 53 48% 36% Sinus/hay fever 50 64.5% 18.5% Shoulder Pain 45 60% 26% Vertigo 42 67% 10% Elbow Pain 38 81% 16% Ankle Pain 35 43% 46.5% Asthma 23 62.5% 23% Edema 22 55% 45% Angina 15 40% 46% Trigeminal N. 11 90% 10% Zoster 10 77% 22% Table
3 (From Survey
2)
Cervicobrachial Syndrome/ Neck and Arm
Pain No. of patients 72 Average No. of
Treatments 7.4 Acupuncture of
benefit?
Yes 87% Frequency of pain Less 18% None - very much
Less 70% Severity of pain Less 10% None - very much
less 77% Effectiveness Rate
Pain: (18 + 70) + (10
+ 70)/2 = 87.5% Limitation of
movement: Improved 26% Full - Greatly
Improved 71% Medication Less 43% None -
Greatly Decreased 46% Sleep Improved 64% Back to normal 19% Pain
duration Helped
group 7.5
years Greatly
helped group 4.3
years Greatly helped With less than 5
treatments 2.1 years More than 5
treatments 5.4
years Table 4 Headache (From Survey 2)
46 Subjects randomly selected for
analysis 29 Myogenic, 14
Vascular/migraine, 3 mixed Average number of
treatments 7.8 Acupuncture of
benefit? Yes 91% Pain Frequency Less 24% None - Much Less 67% Pain severity Less 20% None - Much Less 59% Medication Less 16% None - Much Less 67% Sleep Improved 55% Back to normal 35% Pain duration Helped group 7 years Greatly helped group 6 years Not helped
group 13 years Greatly helped < 5
treatments 5 years duration Greatly helped > 5
treatments 8 years
duration Table 5
Acupuncture of
benefit? Yes
119 No 17 Is the frequency of
PAIN: More? 1% Less? 32% Very much
less? 38% No pain 17% Is the severity of PAIN: More? 2% Less 29% Very much less? 40% No pain 16% Sleep disturbance Less 50% Sleep back to
normal 38% Overall effectiveness rate
87% Greatly helped rate
56% Helped rate
30% Table 6 (Survey 3) Pain Condition No. Average
age Helped Greatly
helped Neck 398 61 24.0% 44.5% Neck only 34 47 13.5% 59.5% Neck & arm 239 58 26.0% 44.5% Shoulder 297 56 26.5% 44.5% Hand 163 57 23.0% 46.0% Back 393 53 29.0% 48.0% Back only 66 47 44.0% 49.0% Sciatica 184 58 17.5% 61.5% Sciatica Only 15 52 20.0% 57.0% Hip 156 58 30.0% 45.5% Knee 206 59 42.5% 52.0% Ankle 107 57 42.5% 48.0% Feet 138 57 22.0% 47.5% Headache 240 52 33.0% 50.0% Head only 29 46 22.0% 42.0% Where Helped = (Less Freq +
Less Severe Pain)/2. (Survey 3) contd. Autonomic
condition No. Age Less V. much less -
Nil Anxiety 230 53 25.5% 55% Vertigo 105 55 20.0% 42% A.M. sickness 14 37 29.0% 57% Period pain 15 34 20.0% 40% P.M.T. 16 37 56.0% 31% Fluid ret 52 51 38.0% 43% Skin disease 53 48 34.0% 42% Chest 63 48 14.0% 64% Sinus/Hayfever 139 48 28.0% 50% Conjunct. 21 52 24.0% 62% Diarrhoea 32 51 19.0% 51% Constipation 42 54 7.0% 54% Shingles 24 62 17.0% 75% (Survey 4)
Freq. % Can't remember 1 0.8% Less than 2 weeks 15 11.8% Less than 1 year 39 30.7% One year plus 72 56.7% Pain Severity Scale 1 -
5 Freq. % No pain 1 1 0.8% 2 4 3.2% 3 37 29.0% 4 38 30.0% Unbearable pain 5 36 28.0% Freq. % Sex Male 57 45% Female 70 55% Age in years < than 30 6 4.7% 30-39 16 12.4% 40-49 17 12.6% 50-59 27
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The Patient's Opinion
First published:
International Journal of Clinical Acupuncture
The second group were
surveyed by mail after about 6 months, with 75% of 478
responding.
The third group were followed up after more
than one year. Questionnaires returned numbered 1146,
representing a 55% response rate. This larger survey was
funded in part by the National Health and Medical Research
Council of Australia (NHMRC).
The fourth survey group was
derived from a random selection of responders to the third
survey after 4 years, 128 questionnaires returned yielding a
35% response.
For the first
three surveys the following questions were asked to gain the
patient's opinion of their response.
The same freq.?
Less freq.?
Much less
freq.?
Entirely relieved?
Unchanged?
Less severe?
Very much less
severe?
Gone?
Greatly improved?
Become
full?
Was your range of movement not limited
before?
In
addition these general questions were asked:
Was acupuncture of benefit to
you?
If your sleep was disturbed, has it improved? Is it
back to normal? Unchanged?
How many practitioners did you
consult prior to acupuncture?
The fourth survey, designed to give information about
musculoskeletal pain patients, was very much more complicated.
Reasons for seeking acupuncture, caffeine intake,
education level, severity of pain, chronicity of pain, and
short and long term response to acupuncture were all assessed.
124 Patients, 100%
follow up @ six weeks plus
Treated
of Benefit?
Movement
of
Treatments
(years)
(CBS)
(Survey
2)
Patient number =
478.
Average follow up 6 months by mail.
Responders = 75%
No. of
practitioners consulted prior to acupuncture = 882.
Av. = 1.84.
Total number of specifically
treated complaints = 912. Av. = 1.98.
Average number of
treatments per patient = 7.8.
Back to
normal 33%
Unchanged
15%
Helped = (less frequent + less
severe)/2
Neck and Arm Pain (CBS)
from 100 survey responders
with headache
(From Survey 2)Low Back Pain. 136
cases.
One
year plus, average follow up.
55%
response to mail survey. 1146 replies.
Greatly Helped =
(Very Much Less Freq + No Pain) + (Very Much Less Severe + No
Pain)/2Table
7
128 replies from randomly selected
musculoskeletal pain patients drawn from survey 3 four years
later.
Reasons for seeking
acupuncture:
"Other forms of
treatment had not helped". -Listed as important by 63%. (n =
80).
"I'd have tried anything if I
thought it would help!" -Listed as important by 61%. (n =
78).