September 12, 2024
Long-Term Effects of Individualized Acupuncture for Chronic Neck Pain
Annals of Internal Medicine
TAKE-HOME MESSAGE
- This randomized clinical trial involving 683 participants evaluated the effects of acupuncture on chronic neck pain. Participants received either high- or low-sensitive acupuncture or sham acupuncture. The primary outcome was a change in the pain score on the visual analogue scale.
- Participants in the acupuncture group had greater reductions in pain scores than those in the sham acupuncture group.
- Clinicians could suggest acupuncture to patients with chronic neck pain. As these alternative procedures become more utilized and studied, clinicians should advocate for coverage of these procedures for patients.
– Owen Hamilton, MD, MPHS
Written by Jennifer E. Svarverud DO, FAAFP
Acupuncture has been used for many years to treat numerous conditions, including neck pain, but the efficacy of acupuncture use has been difficult to quantify. This challenge is due to the inability to blind both participants and practitioners. This study aimed to overcome some of these barriers. The study included 683 participants who were randomized into four treatment groups. This included three acupuncture groups: (1) individuals receiving high-sensitivity acupoint acupuncture, (2) those receiving low-sensitivity acupoint acupuncture, and (3) those receiving sham acupuncture. For the true acupuncture groups, 15 acupuncture points were tested using a pain pressure threshold test (PPT). For the high-sensitivity group, the five most sensitive acupoints, defined as having the largest change in PPT, were selected and each treatment consisted of the five points throughout the study. For the low-sensitivity group, the five acupoints identified as having the least change in PPT were used for each participant. The sham group received needling at five standardized non-acupoints. As control, there was a fourth treatment group that was on a waitlist for acupuncture, with no treatment received. Patients receiving acupuncture received 10 sessions of acupuncture over 4 weeks, with a follow-up of all groups at 24 weeks.
Each of the treatment groups showed improvement in pain control using the visual analog scale. High- and low-sensitivity acupuncture were more effective in reducing pain than sham acupuncture and no treatment (waitlist control) over 24 weeks. However, the clinical significance of acupuncture is unclear, as the magnitude of relative improvement did not reach a minimal clinically important difference, defined as 10 by the researchers. At the 4-week mark, there was no statistical improvement in the net difference in pain control between participants receiving high- and low-sensitivity acupuncture (net difference, –1.97; 95% CI, –5.03 to 1.09). Overall, the study was limited by a complete lack of blinding and limited generalizability.
I have seen firsthand the therapeutic effect of touch on patients in both my practice of acupuncture and osteopathic manipulative therapy, and both are highly sought-after services by patients. The effects are challenging to measure and study, given the inability to completely blind both study participants and practitioners. In my practice, it is common for patients to walk out of my office pain-free following an acupuncture treatment; however, it is difficult to distinguish whether this effect was a result of the acupuncture or the therapeutic relationship formed with the patient. This study highlights that acupuncture utilizing both high- and low-sensitivity points does provide pain relief compared with sham acupuncture and not receiving acupuncture, which corroborates its therapeutic value.
Although further research is needed in the field of acupuncture, it is impossible not to recognize the effect of the therapeutic touch that we, as physicians, have with our patients on a daily basis. In my experience in clinical practice, patients want to be listened to and understood, which is something that lends itself well to acupuncture treatments.
Abstract
BACKGROUND
Long-term effects of individualized acupuncture in persons with chronic neck pain (CNP) remain unknown.
OBJECTIVE
To evaluate the efficacy and safety of pressure pain, sensory-based individualized acupuncture for relieving CNP.
DESIGN
A 24-week multicenter randomized controlled clinical trial. (ChiCTR1800016371).
SETTING
Outpatient settings at 4 clinical centers in China from May 2018 to March 2020.
PARTICIPANTS
716 participants with CNP.
INTERVENTION
Participants were randomly assigned to a waiting list (WL) group or to 1 of 3 interventions, which consisted of 10 sessions over 4 weeks: higher sensitive acupoints (HSA), lower sensitive acupoints (LSA), and sham acupoints (SA) acupuncture groups.
MEASUREMENTS
The primary outcome was the change in the visual analogue scale (VAS) score for neck pain (range, 0 to 100) from baseline to 4 weeks, with a difference of 10 points considered the minimum clinically important threshold. The VAS was also assessed every 4 weeks through 24 weeks.
RESULTS
The modified intention-to-treat population included 683 participants. The mean baseline VAS was 50.36, 50.10, 49.24, and 49.16 for HSA, LSA, SA, and WL, respectively. Compared with a mean baseline to week 4 change of -12.16 in the HSA group, the mean changes were -10.19 in the LSA group (net difference [ND], -1.97 [95% CI, -5.03 to 1.09]), -6.11 in the SA group (ND, -6.05 [CI, -9.10 to -3.00]), and -2.24 in the WL group (ND, -9.93 [CI, -12.95 to -6.90]). The intervention effects persisted at 24-week follow-up.
LIMITATION
Lack of complete blinding and limited generalizability.
CONCLUSION
Individualized acupuncture interventions using high- or low-sensitivity acupuncture points were more effective in reducing CNP than SA and WL control groups sustained through 24 weeks, but the magnitude of relative improvement did not reach a minimal clinically important difference.
PRIMARY FUNDING SOURCE
National Natural Science Foundation of China.