It doesn’t really matter whether it is something that is from time to time, acute or something you live with day in and day out. Pain can range from being a tad unpleasant to something that rules your life. Finding the right method for pain relief is an obvious answer
According to the National Centre for Complimentary and Integrative Health pain relief is the most common reason people seek medical care.
What is pain?
The International Association for the Study of Pain defines pain as an unpleasant physical or emotion feeling or sensation that may be associated with actual tissue damage.
While people may have similar types of pain their personal experience and response to pain can vary dramatically depending on a wide range of issues including social factors, attitude, emotional wellbeing, diet, physical activity and lifestyle.
Pain is broken up into 3 main categories:
- Acute – lasts for a short period of time and is usually associated with some type of injury.
- Chronic – pain that lasts for a period longer than 12 weeks, which can be associated with injury or more internal disease.
- Cancer pain – which occurs at early and late stage of cancer as well as recovery from treatment.
How many people does pain affect in Australia?
In Australia one in five people suffer with chronic pain and this increases to one in three for those over the age of 65 years
Chronic pain is one of Australia’s third highest economics costs and in 2007 was estimated to have been more than $34 billion. This includes losses in productivity, health costs and loss of income.
What are the symptoms of pain?
Pain can be experienced as:
- Dull ache
How is pain diagnosed?
As pain can be as a result of injury of tissue or an indicator of more serious disease a range of tests can be ordered by your medical professional. These may include:
- Physical tests such as mobilisation or palpation
- Blood tests
- CT – scan
- MRI scan
The problem with pain relief medications
It has recently been established that pain management strategies such as pain medication has created a serious problem. In 2015 a recent study states that 33,000 people in the United States dies from opioid related deaths. Nearly half of those were prescribed medications. It has now been labelled the ‘opioid crisis’.
In 2017 an article from Harvard University stated that the United States Food and Drug Authority, FDA, strengthened it’s warning from 2005 regarding the use of Non-Steroidal Anti-Inflammatory Drugs known as NSAIDS
The warnings from the FDA point out:
- Heart attack and stroke risk increase even with short-term use, and the risk may begin within a few weeks of starting to take an NSAID.
- The risk increases with higher doses of NSAIDs taken for longer periods of time.
- The risk is greatest for people who already have heart disease, though even people without heart disease may be at risk.
- Previous studies have suggested that naproxen may be safer than other types of NSDAIDs, but the more recent evidence reviewed by the expert panel isn’t solid enough to determine that for certain.
In January 2018 the Therapeutic Goods Authority, TGA restricted access to products containing codeine due to the opioid crisis that is occurring internationally. This meant even low dose codeine derived medication is now restricted to prescription only.
The TGA states long term ibuprofen use has been found to have risks including:
- Serious internal bleeding
- Kidney failure
- Heart attack
A 16 year Scottish study (1) found long term use of paracetamol (acetaminophen) may have significant negative impact on liver function and a potential for multi-organ failure.
How does Chinese medicine view pain?
Chinese medicine considers pain as an obvious sign that there is inflammation, injury, incorrect function of the body or a combination of these issues. The recognition that the nervous system is what generates the pain signal is a vital clue as to how Chinese medicine may have potential impact with pain conditions. Acupuncture specifically has been shown to influence nerve transmission and as well as endorphin release, your bodies natural pain killers. As the nerves also control some functions of the pain area associated with muscle tension working with the nervous system makes sense.
What are some common pain conditions we see in a Chinese medicine practice?
- Shoulder pain
- Neck pain
- Low back pain
- Knee pain
- Elbow pain
- Period pain
- Digestive pain
- Arthritis pain
- Plantar fasciitis
- Carpal tunnel
What are some pain relief alternatives?
Diet – high sugar and processed food diets place increased stress on our digestive system. The digestive system has a powerful role in immune function which relates to inflammation and pain. Some conditions that could potentially resolve with a normal immune function can become chronic pain conditions. A diet high in fresh vegetables, lean protein and low carbohydrates keeps inflammation to a minimum reducing symptoms. Check here for some useful recipes.
Acupuncture – Numerous studies have shown the strength of acupuncture in assisting with pain relief associated with a number of disorders.
- Low back pain – A review of 32 randomised control trials (2) has shown acupuncture has a positive effect in the treatment of chronic non-specific low back pain in comparison to placebo and improved function. Another review (3) showed acupuncture was found to be superior to NSAIDS in effect when treating acute low back pain.
- Knee osteoarthritis – A systematic review relating to osteoarthritis of the knee showed acupuncture to provide significant pain relief, improved mobility and quality of life (3). Pain relief and mobility was also shown to improve further with treatment for longer than 4 weeks. Acupuncture was also shown to have a stronger effect than standard care (4) suggesting an effective alternative to pain relief medication for people with knee osteoarthritis.
- Sciatica – A review (1) found acupuncture to be 2ndin effectiveness out of 21 interventions for pain intensity related to sciatica. The review showed acupuncture may be superior in effect to drugs and may also increase the effectiveness of drugs when used in conjunction (5).
- Migraine – Acupuncture seems to be at least as effective as conventional preventative medication in reducing migraine frequency (6-8) The review found that acupressure reduced pain, and while acupuncture did not reduce pain it did reduce ibuprofen use (9).
- Post-operative pain – A randomised control trial on acupuncture for pain after total knee arthroplasty found that acupuncture was superior to controlled intervention in post-operative fentanyl use, time to first request for fentanyl and pain intensity (10)
- Lateral elbow pain – in a review acupuncture was shown to be superior to controlled intervention (11)
- Neck pain – acupuncture was found to be superior to controlled intervention or inactive treatment neck pain relief (12).
- Shoulder impingement syndrome (frozen shoulder) – At early stage of Shoulder Impingement Syndrome (SIS), exercise combined with therapies such as kinesio taping, specific exercises, and acupuncture can be considered a first choice of intervention (13)
- Chronic pain – In an extremely large open pragmatic trial (14) 454,920 patients were treated with acupuncture for headache, low back pain, and/or osteoarthritis. Effectiveness ranged between marked and moderate in 76% of cases and 8,727 physicians were involved. A meta-analysis of 17,922 patients (15) from randomized trials found acupuncture to be effective in the treatment of chronic pain and is therefore an appropriate option. A systematic review of 13 Randomised Control Trial found acupuncture to have greater effect than pain relief medication or sham acupuncture.
- Darren G. N. Craig,1 Caroline M. Bates,1 Janice S. Davidson,1 Kirsty G. Martin,1 Peter C. Hayes2 & Kenneth J. Simpson2. Staggered overdose pattern and delay to hospital presentation are associated with adverse outcomes following paracetamol- induced hepatotoxicity. British Journal of Clinical Pharmacology Nov 2011
- Lam M, Galvin R, Curry P. Effectiveness of acupuncture for nonspecific chronic low back pain: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2013 Nov 15;38(24):2124-38.
- Manyanga T, Froese M, Zarychanski R, Abou-Setta A, Friesen C, Tennenhouse M, et al. Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis. BMC Complement Altern Med. 2014;14:312.
- Corbett MS, Rice SJ, Madurasinghe V, Slack R, Fayter DA, Harden M, et al. Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis. Osteoarthritis Cartilage. 2013 Sep;21(9):1290-8.
- Qin 2015 (SR & MA of 11 RCTs; 10 acupuncture vs medications; 1 acupuncture vs sham): Acupuncture may be superior to drugs and may enhance the effect of drugs for patients with sciatica; low quality evidence
- Da Silva AN. Acupuncture for migraine prevention. Headache. 2015 Mar;55(3):470-3.
- Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Vertosick EA, et al. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev. 2016(6):Cd001218.
- Yang Y, Que Q, Ye X, Zheng G. Verum versus sham manual acupuncture for migraine: a systematic review of randomised controlled trials. Acupunct Med. 2016 Apr;34(2):76-83.
- Barlow T, Downham C, Barlow D. The effect of complementary therapies on post-operative pain control in ambulatory knee surgery: a systematic review. Complement Ther Med. 2013 Oct;21(5):529-34.
- Chen CC, Yang CC, Hu CC, Shih HN, Chang YH, Hsieh PH. Acupuncture for pain relief after total knee arthroplasty: a randomized controlled trial. Reg Anesth Pain Med. 2015 Jan-Feb;40(1):31-6.
- Gadau M, Yeung WF, Liu H, Zaslawski C, Tan YS, Wang FC, et al. Acupuncture and moxibustion for lateral elbow pain: a systematic review of randomized controlled trials. BMC Complement Altern Med. 2014;14:136.
- Trinh K, Graham N, Irnich D, Cameron ID, Forget M. Acupuncture for neck disorders. Cochrane Database Syst Rev. 2016(5):Cd004870.
- Dong W, Goost H, Lin XB, Burger C, Paul C, Wang ZL, et al. Treatments for shoulder impingement syndrome: a PRISMA systematic review and network meta-analysis. Medicine (Baltimore). 2015 Mar;94(10):e510.
- Weidenhammer W, Streng A, Linde K, Hoppe A, Melchart D. Acupuncture for chronic pain within the research program of 10 German Health Insurance Funds–basic results from an observational study. Complementary therapies in medicine. 2007;15(4):238-46.
- Vickers, A. J., Cronin, A. M., Maschino, A. C., Lewith, G., MacPherson, H., Foster, N. E., et al. (2012). Acupuncture for Chronic Pain. Archives of Internal Medicine, 172(19), 1444. https://doi.org/10.1001/archinternmed.2012.3654
- Xiang, A., Cheng, K., Xu, P., & Liu, S. (n.d.). The immediate analgesic effect of acupuncture for pain: a systematic review and meta-analysis. Shanghai University of Traditional Chinese Medicine, 2017
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