Stimulated by my first full year of weekly blogs ending on Christmas day, as well as He et al 2019.[1]
I set myself a target at the beginning of the year to write a weekly blog, each centred around a recent acupuncture-related research paper. With this one it looks as though I have succeeded, hurrah!
There have been a lot of interesting and novel research findings this year, and I have learned some cool new terms to boot, from immortal time bias to pylephlebitis. Well the latter is not really cool, but it was new to me anyway.
opioid sparing and withdrawal in chronic pain conditions
The area that is arguably of most pressing interest is the potential for acupuncture to mediate opioid sparing and withdrawal in chronic pain conditions.
This is the third blog devoted to opioids in the last 3 months, so interest and attention in this area is clearly growing. I have even set up a category on the blog labelled ‘Opioids’, and I am expecting to use it quite a lot in 2020.
The first blog on opioids highlighted a paper from the US,[2] where the so called ‘opioid crisis’ developed: fuelled by capitalism, the reward structure of the US healthcare system, online ratings of doctors, and an old banned German drug with a US facelift (oxycodone). The paper was a retrospective study examining the association between the initial healthcare provider seen for new-onset back pain and the risk of being prescribed opioids. The lowest risk by quite a long way was for acupuncturists, although the absolute numbers were low compared with physical medicine practitioners.
I got slightly side-tracked by MC
The second blog on opioids focused on the role of integrative medicine in reducing their prescription in chronic pain.[3] The systematic review highlighted included a couple of papers on acupuncture,[4,5] but I got slightly side-tracked by MC. No not myself, but Medical Cannabis.
The most recent paper, which I am highlighting in this blog, is a systematic review of acupuncture and acupressure in cancer pain. It was published online in JAMA Oncology on the 19th of December 2019.
The group, which included researchers from China, Australia and the US, found 17 RCTs including 1111 patients. Now that is a number with portent! Or perhaps it is just easy to use as a pin number.
Do not use 1111 as your pin number!
They showed that acupuncture was associated with a clinically significant reduction in pain intensity compared with sham, and that acupuncture and auricular acupressure (in open-label studies) were associated with reduced opioid use.
So we are moderately certain (GRADE level of evidence) that acupuncture can reduce pain and opioid consumption. Personally, I think that we should just get on and start using it. The evidence is certainly good enough if we had a powerful lobby backing the technique, but without the latter implementation is painfully slow.
So, I am just writing to Santa for some new shiny lobbying-boots, with which I hope to make some well-place contacts in influential places in 2020.
Merry Christmas…
References
1 He Y, Guo X, May BH, et al. Clinical Evidence for Association of Acupuncture and Acupressure With Improved Cancer Pain: A Systematic Review and Meta-Analysis. JAMA Oncol Published Online First: 19 December 2019. doi:10.1001/jamaoncol.2019.5233
2 Kazis LE, Ameli O, Rothendler J, et al. Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use. BMJ Open 2019;9:e028633. doi:10.1136/bmjopen-2018-028633
3 Hassan S, Zheng Q, Rizzolo E, et al. Does Integrative Medicine Reduce Prescribed Opioid Use for Chronic Pain? A Systematic Literature Review. Pain Med Published Online First: 22 November 2019. doi:10.1093/pm/pnz291
4 Zheng Z, Guo RJ, Helme RD, et al. The effect of electroacupuncture on opioid-like medication consumption by chronic pain patients: A pilot randomized controlled clinical trial. Eur J Pain 2008;12:671–6. doi:10.1016/j.ejpain.2007.10.003
5 Crawford P, Penzien DB, Coeytaux R. Reduction in Pain Medication Prescriptions and Self-Reported Outcomes Associated with Acupuncture in a Military Patient Population. Med Acupunct 2017;29:229–31. doi:10.1089/acu.2017.1234
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