Individualized acupuncture provides long-term relief from chronic neck pain

Key takeaways:

• Both higher and lower sensitive acupoints showed promise in treating neck pain during a 24-week trial.
• However, the clinical implications are “unknown” despite the improvements, researchers noted.

Acupuncture effectively reduced chronic neck pain in adults, according to results of a controlled randomized study published in the Annals of Internal Medicine.

Study participants who received the therapy via highly sensitive acupoints reported measurable pain reduction up to 24 weeks after the start of treatment. However, the changes in pain scoring index used during the study did not reach what the researchers established as a minimal threshold to indicate clinically significant benefit from acupuncture.

According to Ling Zhao, PhD, from the Chengdu University of Traditional Chinese Medicine in China, and colleagues, an estimated 288.7 million people globally have chronic neck pain.

Interventions like nonsteroidal anti-inflammatory drugs are recommended to treat neck pain, but “their long-term use may cause undesirable adverse effects and complications,” they wrote.

The researchers assessed the potential effects of acupuncture — a treatment that has demonstrated effectiveness for several types of pain — in a 24-week randomized controlled trial conducted at four clinical treatment sites in China.

Study investigators randomly assigned 716 adult participants with chronic neck pain to either a waitlist group or to one of three acupuncture interventions that consisted of 10 sessions over 4 weeks. These included a higher sensitive acupoints (HSA) group, lower sensitive acupoints (LSA) group and sham acupoints (SA) group.

Zhao and colleagues measured neck pain using a visual analogue scale (VAS) with a range of 0 to 100, where a 10-point difference between groups indicated a minimal clinically important difference.

The study protocol called for tracking of pain levels every 4 weeks up to 24 weeks.

Baseline mean VAS values included 50.36 for HSA, 50.1 for LSA, 49.24 for SA and 49.16 for the waitlist group.

Zhao and colleagues found that mean changes in VAS from baseline to 4 weeks of:

• –12.16 (95% CI, –14.45 to –9.87) with HSA;
• –10.19 (95% CI, –12.43 to –7.95) with LSA;
• –6.11 (95% CI, –8.31 to –3.91) with SA; and
• –2.24 (95% CI, –4.1 to –0.38) with the waitlist.

These effects continued through 24 weeks, the researchers noted, while no serious adverse events were seen in any of the four groups.

Regarding potential mechanisms behind the findings, “acupuncture could reduce the intensity of pain through modulation of the nerve system by acupuncture points,” Zhao and colleagues suggested.

There were some study limitations outlined by the researchers. For example, the inability to blind the waitlist group to the assigned treatment option.

The study groups comprised middle-aged adults with moderate pain, thus hurting the general applicability of results to older adults with severe pain.

The researchers explained that the clinical importance of the findings is “unclear” despite the improvement.

Still, the results “suggest that the selection of pressure pain, sensory based objective acupoints” could be considered as treatment for chronic neck pain, they concluded.