Tuesday, January 23, 2018

Research Review: Key Research Papers when Discussing Acupuncture for Pain Management with a Physician

key words: research literacy, acupuncture research, integrative medicine, evidence-based medicine, pain medicine,  integrative pain management, research in integrative medicine, integrative health,  neuroplasticity, mu-receptor and opioids, opioid-based medications, analgesia, duration of the effects of acupuncture, brain science and neurology, biomedicine review, communicating with referring providers, quality research useful in health care policy, acupuncture research for health care policy

topics:  evidence-based acupuncture, research literacy, communication with referring providers

Find yourself talking with physicians about acupuncture and the research base for acupuncture as an evidence-based non-pharm therapy for pain relief and recovery? 

Mel Hopper Koppleman, MSc of A Better Way to Health and major contributor to the new, breakthrough international community project, Evidence-Based Acupuncture, recently answered the question,
"If you had to present 3 studies to a neurologist showing the efficacy of acupuncture for chronic pain which ones would you use?"

In just 16 minutes (perfect to watch during your lunch break!), Mel chooses several studies to meet 3 useful criteria when talking with a neurologist.
The criteria categories:

  1. the effects of acupuncture are long-term and thus acupuncture is not a placebo
  2. acupuncture treatment improves neuroplasticity
  3. acupuncture treatment affects the mu-opioid receptors (MOR)

Review your research literacy skills and learn why these 3 categories of research on acupuncture for pain are Mel's favorite when you watch this video.
This video is part of the EBA Connect resources.  For full access, become an EBA Connect member.

Want to see more content
The Vickers et al study supports the efficacy of acupuncture for chronic pain and demonstrated that acupuncture treatment is superior to sham or control for each condition.

Pain Relief Effects of Acupuncture Tx Course Persisted
The May 2017 MacPherson review showed that the effects of acupuncture in pain relief persisted several months after the treatment course ended.  
quotes from the study:
"Data on longer term follow available for 20 trials, including 6376 patients"
"90% of benefit of acupuncture relative to controls...sustained at 12 months"
Acupuncture is Not a Placebo
The Jackson et al study on the comparative effectiveness of migraine treatments had a large data set for placebo (sugar pill) for migraines.  This data set shows that while placebo can be beneficial, it has short term effects.  Placebo is not effective long term.  The conclusion here is acupuncture, with demonstrated long-term effects, is thus not a "placebo" treatment.

A Course of Acupuncture Treatment Improves Neuroplasticity
The study published in Brain, a Journal of Neurology used the Boston CTS questionnaire, a median nerve conduction test, and fMRIs in their metrics.  This study observed:
  • verum acupuncture demonstrated improvement in neuroplasticity
  • verum acupuncture improved nerve conduction and cortical separation distance with sustained improvements still noted at the 3-month follow-up.  
Acupuncture Treatment increases Mu-Opioid Receptor Binding (MOR)
The Harris et al study focused on mu-opioid receptors (MOR).  One of the study conclusions was that verum acupuncture increased MOR-binding.  So, this may be what patients who receive acupuncture are able to decrease their need for opioid-based medications for pain relief.

You can read and support (through EBA Connect) more of Mel's work at Evidence-Based Acupuncture.  

Useful 2014 review article by John McDonald, Allan Cripps, and Peter Smith about how acupuncture works from a biomedical perspective, based on recent mechanistic research:  "Mediators, Receptors, and Signalling Pathways in the Anti-Inflammatory and Antihyperalgesic Effects of Acupuncture".  
John L. McDonald, Allan W. Cripps, and Peter K. Smith, “Mediators, Receptors, and Signalling Pathways in the Anti-Inflammatory and Antihyperalgesic Effects of Acupuncture,” Evidence-Based Complementary and Alternative Medicine, vol. 2015, Article ID 975632, 10 pages, 2015. doi:10.1155/2015/975632

Related Blogposts
Learn more about the mu-opioid receptor's role in pain and get CEUs--ReachMD audiovisual presentation on "Comprehensive Pain Management in Palliative Care:  Relieving the Burden of Opioid-Induced Constipation"

The Field of Acupuncture Research in Just 10 Minutes, another video with Mel

More about the Acupuncture in the Opioid Crisis, including resources on calculating morphine equivalent dosage (MED, MEQ), and review of systems with focus on side effects of opioid medications

A Validated Pain Scale for the Biopsychosocial, patient-centered clinic care model

The Studies Referenced in the Video
Vickers, AJ, Cronin A.M., Maschino A.C., Lewith G., MacPherson H, Foster et. al. (2012).  Acupuncture for Chronic Pain.  Archives of Internal Medicine, 172 (19), 1444. 

MacPherson, H., Vertosick, E.A., Foster, N.E., Lewith, G, Linde K, Sherman, K.J., et al. (2017).  The persistence of the effects of acupuncture after a course of treatment:  a meta-analysis of patients with chronic pain.  Pain, 158(5), 784-793.

Jackson, J.L, Cogbill, E., Santana-Davila, R. and Eldredge, C. (2015).  A comparative effectiveness meta-analysis of drugs for the prophylaxis of migraine headache. PLoS ONE.

Maeda, Y., Kettner, N., Lee, J., Kim, J., cina, S., Malatesta, C., et al. (2013).  Acupuncture Evoked Response in Contralateral Somatosensory Cortex Reflects Peripheral Nerve Pathology of Carpal Tunnel Syndrome.  Medical Acupuncture, 25(4), 275-284.

Harris, R.E., Zubieta, J.K., Scott, D.J., Napadow, V., Gracely R.H., and Clauw, D.J. (2009).  Traditional Chinese Acupuncture and Placebo (Sham) Acupuncture Are Differentiated by Their Effects on 𝞵-Opioid Receptors (MORs)NeuroImage, 47(3), 1077-1085.

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