'Quite a bit of data' support acupuncture for pain management

Key takeaways:

• Acupuncture could be a beneficial treatment for several areas of pain.
• An “enormous explosion” of evidence spanning 2 decades supports this conclusion, an expert said.

BOSTON — Acupuncture can be an effective treatment for several types of pain, according to a speaker at the annual ACP Internal Medicine Meeting.

Astrid Pujari, MD, medical director of the Center for Integrative Medicine at Virginia Mason Medical Center in Seattle, Washington, discussed acupuncture as a “subset of complementary and alternative medicine,” which she said focuses on natural interventions before more invasive treatments.

“Integrative medicine includes things like nutrition, a lot of emphasis around healing in terms of lifestyle changes,” Pujari said. “It'll include things around supplements, botanicals, bodywork modalities, which is where this comes in.”

Pujari, who pursued this field after leaving her primary care practice, detailed the recent history of acupuncture evidence. In 2003, WHO recognized about 100 conditions that seemed to benefit from acupuncture, which led to “an enormous explosion of research” over the next 20 years, including more than 13,000 studies in 60 countries, she said.

“If there’s one thing you can remember for acupuncture, it’s that [there are] quite a bit of data to support it for pain in many different arenas,” Pujari said.

Research has shown that acupuncture is effective for chronic low back pain, general chronic pain, migraines, tension headaches and knee osteoarthritis, she said.

“Acupuncture has been shown to stimulate the release of endogenous opiates in the body,” Pujari said. “It also increases opioid receptor binding potential in the brain. ... And over time, it works more effectively.”

Pujari highlighted several meta-analyses and randomized clinical trials that support acupuncture for chronic pain.

For example, a 2012 meta-analysis of 29 randomized trials and 17,922 patients showed that patients who received acupuncture had lower pain scores than the control group. For chronic headache, the acupuncture group had a score that was 0.15 SDs (95% CI, 0.07-0.24) lower; for osteoarthritis pain, the group’s score was 0.16 SDs (95% CI, 0.07-0.25) lower; and for back and neck pain, it was 0.23 SDs (95% CI, 0.13-0.33) lower.

“With the opiate crisis and all that, we're trying to figure out ways to treat pain that may not be so pharmaceutical, right? So it can be really practical in clinic,” Pujari said.

Pujari noted that the ACP and NIH both have guidelines including acupuncture. The ACP practice guidelines for noninvasive treatments for chronic, acute and subacute low back pain, published in 2017, recommend chiropractor, superficial heat massage or acupuncture. It is a strong recommendation.

“This is our very own ACP. The NIH also recommends acupuncture for low back pain. Medicare has also approved acupuncture — that’s saying a lot, right?” Pujari said. “Acupuncture can be helpful for pain, especially chronic pain.”

References:

• Pujari A. Complementary and alternative medicine: Acupuncture — a review of the evidence. Presented at: ACP Internal Medicine Meeting; April 18-20, 2024; Boston.
• Vickers AJ, et al. Arch Intern Med. 2012;doi:10.1001/archinternmed.2012.3654.