Acupuncture for chronic pain and pain vulnerability
With Dr Karen H Simpson | 28 May 2015 | Print
Dr Karen H Simpson is a consultant in anaesthesia and pain medicine, Leeds, UK.
Acupuncture for chronic pain
Vickers AJ, Linde K. J Am Med Assoc 2014;311:955-956.
It is interesting to see a paper from an academic center in an international journal considering the question of whether acupuncture is associated with reduced pain outcomes for patients with chronic pain compared with sham-acupuncture (placebo) or no-acupuncture control. Many years ago this would not have been a topic for a high impact journal.
The authors examine the case for acupuncture carefully and their conclusion is clear. Acupuncture is associated with improved pain outcomes compared with sham-acupuncture and no-acupuncture control, with response rates of approximately 30% for no acupuncture, 42.5% for sham acupuncture and 50% for acupuncture.
Pain vulnerability: a neurobiological perspective
Denk F, McMahon SB, et al. Nat Neurosci 2014;17:192-200.
The authors have produced a well-written paper that considers in detail an area that is poorly understood: the biological basis linking risk factors for chronic pain conditions to abnormal processing of pain signals. This review is well worth reading and deals with some of the potential mechanisms that may underlie vulnerability and resilience towards developing chronic pain. They include genetic/epigenetic processes, priming effects on a cellular level and alterations in the brain networks concerned with reward, motivation/learning and descending control. The paper gives glimpses of how an understanding of these factors may open new therapeutic possibilities.
Further key clinical papers
Mechanisms of acupuncture-electroacupuncture on persistent pain.
Zhang R, Lao L, et al. Anesthesiology 2014;120:482-503.
Pain psychology for the non-psychologist.
McGuigan PJ, Orr K. Br J Anaesth 2014;112:576.
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