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Senior Citizen Health & Medicine
Acupuncture Reduces Chronic Neck Pain; Massage
Benefits Still Unclear
By Laura Kennedy, Contributing Writer
Health Behavior News Service
 August
17, 2006 - Acupuncture offers relief from chronic neck pain,
while there is little reliable evidence on the effectiveness of massage,
according to two new systematic reviews. Acupuncture does not cure
neck pain, and relief appears to last only a few weeks or months.
Patients may thus need periodic booster treatments, says lead study
author Kien Trinh, M.D., of McMaster University in Canada.
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The massage review concludes, Due to the
limitations of existing studies, we are unable to make any firm
statement to guide clinical practice. Bodhi Haraldsson, a registered
massage therapist in British Columbia, Canada, led the study team.
The two studies are part of a series designed to
summarize the most current scientific evidence on treatments for neck
pain due to mechanical problems such as whiplash and muscle strains.
Such injuries are common, disabling and costly.
Ten percent of males and 17 percent of females
report neck pain that lasts longer than six months, according to a study
cited in the massage review. Both new reviews excluded patients with
neck pain caused by major illnesses or injuries such as viral infections
or fractures.
The reviews appear in the most recent issue of The
Cochrane Library, a publication of The Cochrane Collaboration, an
international organization that evaluates medical research. Systematic
reviews draw evidence-based conclusions about medical practice after
considering both the content and quality of existing medical trials on a
topic.
The acupuncture study comprised 10 trials with a
total of 661 adult participants. The studies compared a number of
acupuncture approaches to no treatment, sham treatments or other manual
therapies such as mobilization, massage or traction. Most of the
studies included at least five treatment sessions.
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About Acupuncture |
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Acupuncture is sometimes used as an alternative to more
traditional treatments for musculoskeletal pain. In this review
it was defined as the stimulation of one or more specific points
on the body, by the insertion of needles, to achieve a desirable
effect. Acupuncture typically includes manual stimulation of
needles, but there are commonly used variations, such as
electrical stimulation or heat stimulation of the needles, which
is called moxibustion (the moxa herb, Artemisia vulgaris, is
burned at the handle end of the needle). Injection acupuncture,
in which herbal extracts are injected into acupuncture points,
is occasionally used as well.
It is unclear which type of acupuncture produces the most
beneficial effect. |
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The specific effects of acupuncture are
short-term, but have important clinical treatment benefits, conclude
the review authors.
These findings are based on a wide range of
patients, treatment techniques and outcomes, said Dr. Partap Khalsa at
the National Center for Complementary and Alternative Medicine. The next
step is to conduct more well-defined studies to optimize the findings,
said Khalsa, who was not involved with either review.
For some subgroups of patients with mechanical neck
disorders, he said, acupuncture may be the best treatment while
different options may provide greater relief for others. We just dont
know that right now.
Trinh calls for larger and longer trials
preferably at least 500 patients and follow-up after a year or more to
further expand understanding of acupuncture treatment.
The review of massage techniques comprised 19
trials involving nearly 1,400 adults. The trials compared massage alone
or in combination with other treatments to no treatment, sham
treatments, mobilization, traction, acupuncture, exercise, education and
pain medication.
The authors report that the overall quality of
these trials was poor. In some cases, it was questionable whether the
massage in the study would be considered effective massage under any
circumstance. No firm conclusions can be drawn at this time, they
conclude.
One of the most important functions of the
Cochrane Library is to demonstrate what we do not know, according to
Bandolier, an independent British journal focusing on evidence-based
healthcare. Good quality reviews that find no trials, no good trials or
good trials with no effect are really important in delimiting the extent
of our knowledge (or ignorance).
The authors of the massage review call for pilot
studies to define an optimal massage intervention including techniques
along with number, duration and frequency of treatment sessions which
can then be evaluated in subsequent larger trials. In short, said Khalsa,
researchers must go back to ground zero, in studying massage
treatments for chronic neck pain.
Khalsa said that many Americans from the lay
public to physicians and scientists have preconceived beliefs about
alternative treatments. Many are inclined to believe that acupuncture is
ineffective while massage is helpful, and they may dismiss the recent
findings.
The new information will be most useful for people
who are neutral, who are saying show me what the evidence actually is,
and I will use that to inform my own decisions, he said.
Khalsa advises patients to consider using such
therapies to complement conventional medicine, rather than just as an
alternative. Thats something patients need to discuss with their
physicians, Khalsa said, and this could include doctors of medicine,
osteopathy, chiropractic and/or physical therapy.
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More About Chronic Pain
What is Chronic Pain?
While acute pain is a normal sensation triggered in the
nervous system to alert you to possible injury and the need
to take care of yourself, chronic pain is different. Chronic
pain persists. Pain signals keep firing in the nervous
system for weeks, months, even years. There may have been an
initial mishap -- sprained back, serious infection, or there
may be an ongoing cause of pain -- arthritis, cancer, ear
infection, but some people suffer chronic pain in the
absence of any past injury or evidence of body damage.
Many chronic pain conditions affect
older adults.
Common chronic pain complaints include
headache, low back pain, cancer pain, arthritis pain,
neurogenic pain (pain resulting from damage to the
peripheral nerves or to the central nervous system itself),
psychogenic pain (pain not due to past disease or injury or
any visible sign of damage inside or outside the nervous
system).
Is there any treatment?
Medications, acupuncture, local electrical stimulation, and
brain stimulation, as well as surgery, are some treatments
for chronic pain. Some physicians use placebos, which in
some cases has resulted in a lessening or elimination of
pain. Psychotherapy, relaxation and medication therapies,
biofeedback, and behavior modification may also be employed
to treat chronic pain.
What is the prognosis?
Many people with chronic pain can be helped if they
understand all the causes of pain and the many and varied
steps that can be taken to undo what chronic pain has done.
Scientists believe that advances in neuroscience will lead
to more and better treatments for chronic pain in the years
to come.
What research is being done?
Clinical investigators have tested chronic pain patients and
found that they often have lower-than-normal levels of
endorphins in their spinal fluid. Investigations of
acupuncture include wiring the needles to stimulate nerve
endings electrically (electroacupuncture), which some
researchers believe activates endorphin systems. Other
experiments with acupuncture have shown that there are
higher levels of endorphins in cerebrospinal fluid following
acupuncture. Investigators are studying the effect of stress
on the experience of chronic pain. Chemists are synthesizing
new analgesics and discovering painkilling virtues in drugs
not normally prescribed for pain.
National Institute of Neurological
Disorders & Stroke
click for more
More
Links for Senior Citizens
●
Aging with Ease: A Positive Approach to Pain Management
(Alliance for Aging Research) - Links to PDF
●
Assessing Pain in Loved Ones with Dementia (AGS
Foundation for Health in Aging) - Links to PDF
●
Eldercare at Home: Pain (AGS Foundation for Health in
Aging)
●
Persistent Pain (AGS Foundation for Health in Aging)
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