The effect of acupuncture on patients with neck pain
Last week I provided some studies that look at the effect of acupuncture on patients with knee osteoarthritis. To me it is clear that the placebo response is a big part of why patients feel better, but it is also a within the realm of reasons that patients have a complex biopsychosocial response to acupuncture that INCLUDES but is not LIMITED to placebo.
This week, I have provided an introduction to the use of acupuncture or other needle based treatments for neck pain. There is a considerable amount of scientific evidence that patients with neck pain benefit from acupuncture treatments. The primary measurement used in a majority of these papers are pain scores but there is also a recent article that uses elastography to measure tissues changes post treatment.
A Review of The Literature
Reading the research, there is compelling evidence that acupuncture is an effective way to manage neck pain. Yet, there is still no shortage of folks who seem to want to cast acupuncture in the most negative possible light to create a convenient straw man. The suggestion that all needling is useless conflicts with scientific data published in reputable journals, done by researchers from reputable medical institutions:
• A 2016 systematic review, published by The Cochrane Collaboration
• A 2016 meta-analysis, published by Nature Publishing Group
• A 2016 review, published by the Mayo Clinical Proceedings
• A 2016 randomized control trial, published in Pain
• A 2016 randomized control trial, published in The Journal of Manual & Manipulative Therapy
• A 2016 study, published in PM&R
• A 2016 randomized control trial, published in The Archives of Physical Medicine and Rehabilitation
• A 2015 systematic review, published in Spine
• A 2015 randomized trail, published in the Annals of Internal Medicine
• A 2015 study, published in PM&R
• A 2015 randomized trail, published by Pain Physician
• A 2015 systematic review, published in The Journal of Manual & Manipulative Therapy
• A 2015 systematic review, published in The American Journal of Physical Medicine & Rehabilitation
• A 2014 randomized controlled trail, published by Acupuncture in Medicine
• A 2013 meta-analysis, published in The Journal of Orthopaedic & Sports Physical Therapy
• A 2012 meta-analysis, published in JAMA Internal Medicine
• A 2007 systematic review, published in Spine
• A 2006 study of 14,161 patients, published in Pain
• A 2006 randomized controlled trail, published in Pain
The Newest and Least Biased Research
Some of the most favorable scientific evidence available is also the newest and least biased. This includes a Cochrane Systematic Review that states:
"Moderate-quality evidence suggests that acupuncture relieves pain better than sham acupuncture, as measured at completion of treatment and at short-term follow-up, and that those who received acupuncture report less pain and disability at short-term follow-up than those on a wait-list. Moderate-quality evidence also indicates that acupuncture is more effective than inactive treatment for relieving pain at short-term follow-up."
The preponderance of evidence is that acupuncture yields short and long-term improvement in function and pain relief in patients who suffer from neck pain. There is also evidence to suggest that acupuncture decreases tissue stiffness and improves range of motion.
As I see it, acupuncture is not a panacea, it is just another option among several that work more or less the same. To help science based clinicians better understand acupuncture it is easiest to view acupuncture as a form of peripheral nerve stimulation. Needle insertion is based on an understanding of anatomy and neurophysiology and acknowledges the fact that, regardless of where the needle is inserted (skin, fascia, muscles, tendons, periosteum, joint capsules etc.), there will be a number of physiological responses across different areas of the nervous system, this includes, but is not limited to: peripheral receptors, dorsal horn of the spinal cord, and sensorimotor cortical areas.
I hope this brief review of the research has provided some with food for though and I invite you to draw your own conclusions.