Currently viewing the tag: "psychological"

In medicine we regard pain as a symptom associated with an injury or some type of pathological process. However this excludes a large proportion of sufferers with psychological pain where there is no obvious physical cause. Unlike acute pain which usually has an organic cause, patients with psychological ailments have no obvious cause of the pain. In the same way, chronic pain is also not a benign entity; the pain is continuous, can be disabling, lead to depression and overall the patients have a very poor quality of life. Often it is not just physical but also related to emotional and psychological reasons. Currently, it is estimated that anywhere from 3-7% of the population may have chronic or psychological pain.

psychological pain

Over the years many treatments have evolved for the treatment of psychological pain but none has proven to be effective in all patients. The traditional analgesics do not appear to work and with the current opiate crisis, these agents are no longer recommended. Most other drug therapies that include antidepressants and anticonvulsants do not reliably provide any significant pain relief in all patients. Plus, these drug therapies often have potent adverse effects, are costly and may be addictive.

Because of the failure of conventional therapies to manage psychological pain, many patients have been turning to acupuncture. This old Chinese treatment has been used to treat pain from a variety of causes with good success. Most of the literature on the benefits of acupuncture has looked at acute causes of pain but its role in the management of psychological pain has not been fully evaluated. The few studies published on the benefits of acupuncture for psychological pain appear confusing, with some reports indicating that the treatment works and others claiming that acupuncture does not work for psychological pain. Most of the older acupuncture studies with large numbers of participants were not randomized and the outcomes of pain relief were not always quantified, hence data from these studies are difficult to assess. Overall, these older studies have indicated that about 50% of patients with chronic or psychological pain do obtain some pain relief over time. Unfortunately, the studies did not indicate which patient would benefit from the treatment.

So what is the present status of acupuncture for psychological pain?

Recently researchers analyzed 6 studies involving 462 patients who had chronic pain. The patients were between 52-63 years of age and received treatment for a minimum of 8 weeks.

Unfortunately, the quality of evidence from these studies was low because the treatment was not compared to sham acupuncture and the participants were not blinded. The number of participants in some studies was small. Overall, the researchers stated that they simply did not have evidence to refute or support the use of acupuncture for chronic or psychological pain.

However, since the treatment is relatively safe when done by an experienced practitioner, it may be an option for an individual who has failed to respond to other conventional pain treatments.

Dr. Lucy Chen, a specialist in pain medicine and a practicing acupuncturist who works at the Harvard affiliated Massachusetts General Hospital states, “I think the benefit of acupuncture is clear, and the complications and potential adverse effects of acupuncture are low compared with medication.” More important acupuncture is not as costly as drug therapy nor does it cause physical or psychological dependence. So for patients with psychological pain, it may be worth a try.

 

References

  1. Research Finds Acupuncture Effective for Chronic Pain.(2018, May 21) https://www.aafp.org/news/health-of-the-public/20180521acupuncture.html
  2. Vickers AJ, Linde K. Acupuncture for chronic pain. JAMA. 2014;311(9):955–956. doi:10.1001/jama.2013.285478
  3. Yang Z, Zhao L, Xie X, et al. The effectiveness of acupuncture for chronic pain with depression: A systematic review protocol. Medicine (Baltimore). 2017;96(47):e8800. doi:10.1097/MD.0000000000008800
  4. Vickers AJ, Vertosick EA, Lewith G et al. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. J Pain. 2018; 19(5): 455-474.
  5. Ingraham P. Does Acupuncture work for pain. (2018, Jun 13). https://www.painscience.com/articles/acupuncture-for-pain.php
  6. Ju ZY, Wang K, Cui HS, et al. Acupuncture for neuropathic pain in adults. Cochrane Database Syst Rev. 2017;12(12):CD012057. Published 2017 Dec 2. doi:10.1002/14651858.CD012057.pub2
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Chronic pain affects a significant number of people worldwide. The exact number of people with chronic pain is not known but the numbers are not minuscule. For decades, acupuncture has been used to manage several types of acute and chronic pain disorders.  The therapy utilities very fine needles that are inserted at specific anatomical sites in the body for pain relief. When performed by a qualified acupuncturist, the treatment is said to provide pain relief and has a very good safety profile. Over the years, this old Chinese remedy has been used to manage a variety of pain disorders including joint pain, migraine, sciatica, neck pain, and even headaches. 

Recently a meta-analysis of dozens of high-quality clinical trials that involved nearly 18,000 participants showed that acupuncture is an effective treatment for individuals with neck and back pain, chronic headache, osteoarthritis, and shoulder pain. In addition, one large randomized control study revealed that acupuncture significantly lowered symptoms of depression at 12-weeks compared with traditional therapies. Finally there are other studies showing that acupuncture can also lower the depression associated with cancer and enhance the quality of life.

However, to put things into perspective, there are just as many studies showing that acupuncture has none or only mild pain-relieving effects.

Today, the effectiveness of acupuncture for the treatment of pain continues to be debated. The reason why some patients benefit from acupuncture and others do not has not been well explained. So what is the issue? Does the technique work for pain or not?

Acupuncture is one of the oldest complementary therapies to manage pain and there is evidence from clinical trials that the technique can help lower pain. While many factors that influence acupuncture have been studied in the past, the patient’s psyche, his or her relationship with the acupuncturist and beliefs have not been thoroughly studied, until this recent study.

Now a study by researchers from the University of Southampton sheds more light into this controversy. The lead investigator, Dr. Felicity Bishop from the University conducted this study to determine why some individuals with low back pain gained more pain relief from acupuncture and others did not. What the researchers observed is that individuals with low back pain who have apriori low expectations of acupuncture before the start of the treatment generally gain less benefit than those individuals who believe it will work. Overall the study revealed that individuals who have a positive view of their pain and who feel in control of their health condition had led back-related disability over the course of acupuncture treatment. The findings of this study were just published in the Journal of Clinical Pain.

In this study, it was shown that psychological factors were consistently associated with back pain-related disability. Patients who started out with very low expectations of acupuncture and thought that the treatment would not help them, in fact, had the least benefit. Further, the same patients who changed their psyche and started to develop positive feelings about their pain, then went on to experience less back-related disability; and as their desire to understand why they were having pain increased, they experienced less pain. In summary, patients who were less emotional conflicts and fewer negative feelings about acupuncture and their pain had more benefits.

What this study shows is that perhaps clinicians need to start motivating or help change patient perceptions about their pain and the potential benefits of acupuncture. Improving the psyche is the key and this may be the reason why there is such a great variance in past acupuncture studies and pain control.

Dr. Bishop has stated that to improve the outcomes after acupuncture, acupuncturists should now consider improving the patient’s psyche and positivity about their pain as part of the initial consultation.

Dr Stephen Simpson, director of research at Arthritis Research UK, said: “This study emphasizes the influence of the placebo effect on pain. The process whereby the brain’s processing of different emotions in relation to their treatment can influence outcome is a really important area for research.” He went on to add,

“Factors such as the relationship between practitioner and patient can inform this and we should be able to understand the biological pathways by which this happens. This understanding could lead in the future to better targeting of acupuncture and related therapies in order to maximize patient benefit.”

 

References

  1. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012; 172(19): 1444-53.
  2. University of Southampton. Psychological factors play a part in acupuncture treatment of back pain. (2015, Feb 12) https://www.sciencedaily.com/releases/2015/02/150212065036.htm
  3. Felicity L. Bishop, Lucy Yardley, Philip Prescott, Cyrus Cooper, Paul Little, George T. Lewith. Psychological Covariates of Longitudinal Changes in Back-related Disability in Patients Undergoing Acupuncture. The Clinical Journal of Pain, 2015; 31 (3): 254
  4. Fields, Rd. Acupuncture Works–Sort of Acupuncture: Physiology, Psychology, or Placebo? Psychology Today. (2010, Sep 27) https://www.psychologytoday.com/intl/blog/the-new-brain/201009/acupuncture-works-sort
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