The overuse and over prescription of medications which contain opioids for pain is a hot topic and has been receiving more media attention of late.
Opioids, sometimes called narcotics, include strong prescription pain relievers. Examples of opioid medications include oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid. Some opioids are made from the opium plant, and others are synthetic (man-made).
According to a research paper by Chen et al. (2018), we are still dealing with the aftermath of opioids' use in the US civil war and that 'acupuncture is colliding with the opioid crisis not by accident but by necessity'. 'It is time to optimise our tactics and make sure that our therapies are not misaligned.'
A paper by Yin Fan et al. highlights that the United States is facing a national opioid epidemic and that medical systems need a non-pharmacological strategy to reduce the public's opioid dependence. The authors maintain that acupuncture can be an evidence-based, safe and cost-effective way to meet these needs.
Here in Ireland, the use of opioids is not at the dangerous levels seen in the US and the UK; however, we are not too far behind, so I understand. Trends set in larger countries often tend to influence healthcare trends in smaller countries.
Of the opioids, tramadol seems to be one the most commonly prescribed in our area, often as part of the 'orthopaedic cocktail' used for treating acute musculoskeletal pain. As a short term fix, I believe sensible usage has its advantages. I have a handful of clients each year whose GP's I ask to prescribe the cocktail if they are in real trouble and need some medicinal help to help facilitate physiotherapy and rehabilitation. These are usually clients with acute lower back pain.
The problem is when short term use turns into long term use of possibly dependence. From my experience, this often occurs when clients are either not referred for, or do not receive proper conservative (i.e. physiotherapy) treatment to help alleviate pain and restore function. Again from experience, I have found that any approach that integrates the use of medical acupuncture, usually most effective.
There not many studies (yet) considering the role of acupuncture in reducing opioid use specifically. One of the better studies is by Crawford et al. (2017) who followed 172 consecutive patients who received at least four sessions of acupuncture over one year at a US military family medicine practice. Medication consumption was compared over the 60 days before being treated with acupuncture for the first time with the same period one year later. The reduction in opioid use was 45%.
I would expect to see more studies in the coming years evaluating the role of acupuncture to reduce opioid dependency given acupuncture has already been shown to successfully treat chronic pain, according to Vickers & Linde (2014) and others.
It would be helpful if the broader medical community (who may be less familiar with acupuncture mechanisms) were to move beyond the unhelpful placebo arguments and instead embrace the effectiveness of acupuncture simply as a neuro-endocrine modulatory technique.... which is not always dependant on needle location.
Chen WG, Niemtzow RC, Belfer I, Helms JM, Kligler B, Langevin H, Volf N. Acupuncture Versus Opioids for Pain Relief: An Expert Discussion. Medical Acupuncture. 2018 Dec 1;30(6):290-5.
Crawford P, Penzien DB, Coeytaux R. Reduction in pain medication prescriptions and self-reported outcomes associated with acupuncture in a military patient population. Medical acupuncture. 2017 Aug 1;29(4):229-31.
Fan AY, Miller DW, Bolash B, Bauer M, McDonald J, Faggert S, He H, Li YM, Matecki A, Camardella L, Koppelman MH. Acupuncture's Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management–White Paper 2017. Journal of integrative medicine. 2017 Nov 1;15(6):411-25.
Vickers AJ, Linde K. Acupuncture for chronic pain. Jama. 2014 Mar 5;311(9):955-6.
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