ANESTHESIA AND ANALGESIA . . . Current Researches VOL. 55, No. 2, MARCH-APRIL, 1976
229
Incidence of Prolonged Pain Relief Following Acupuncture PETER K.
Y.
LEE, M D *
JEROME H. MODELL, M D t THORKILD W. ANDERSEN, M D $ SEGUNDINA A. SAGA, MDS
Gainesville, Florida 11
From March 1973 t o December 1974, 2090 electroacupuncture treatments were applied to 533 patients with chronic pain. Of 533 patients, 276 (52%) reported excellent (>750/0) pain relief immediately a f t e r t h e l a s t treatment, and 103 (19.3%) still reported excellent pain relief on a &week follow-up questionnaire. I n March 1975, t h e authors contacted 87 of these 103 patients. Sixty-three reported t h a t they
still had excellent pain relief 3 t o 18 months a f t e r therapy, 3 patients reported t h a t their pain still was relieved 50%, and 21 patients said their pain had returned t o t h e same intensity as before therapy. Thus, 12% of 533 patients who received acupuncture treatment f o r chronic pain had a significant degree of pain relief a t least 3 months a f t e r therapy.
W
of this report is to identify those patients who received relief from pain for more than 3 months after acupuncture therapy.
reported on 261 patients who received up to 4 consecutive acupuncture treatments for chronic pain.' In that study, 133 patients were treated with electrically stimulated needles placed in traditional acupuncture meridians. The remaining 128 patients also received electrical-needle stimulation; however, these had been placed alternately in traditional meridians and in arbitrary locations. We found that 117 patients (54%) reported that their pain was either relieved completely or had decreased in intensity by at least 75% immediately after the 4th treatment. In a 4-week follow-up questionnaire, 47 (18.6%) of the 252 patients who responded still had at least 75% relief from pain.' Needle placement did not influence the results in that study. We have continued to study patients using this modality, to determine the incidence of long-term pain relief. The purpose E PREVIOUSLY
METHODS Between March 1973 and December 1974, 2090 acupuncture treatments were applied to 533 patients suffering from chronic pain. All patients received 3 treatments on successive days and most returned for a 4th treatment. Results of the 4-week follow-up were reported previously in 252 patients (9 patients did not answer the 4-week questionnaire) .1 The remaining 272 patients were treated similarly with needles being placed at traditional meridian points. These have not been reported. Electroacupuncture was performed via 27-gauge hypodermic needles by an electric stimulator with 0.35 ms pulse width; biphasic-capacitor-coupled square wave; pulse rate 10 to 300/sec; and
*Visiting Research Professor. ?Professor and Chairperson. $Professor. $Assistant Professor. IlDepartment of Anesthesiology, University of Florida College of Medicine, J. Hillis Miller Health Center, Gainesville, Florida 32610. Paper received: 7/10/75 Accepted for publication: 8/14/75
ANESTHESIA AND ANALGESIA . . . Current Researches VOL.55, NO. 2, MARCH-APRIL, 1976
230
amplitude 0 to 12 volts variable control. The adjustable controls were set to 200 pulses/sec and 3 volts. The amplitude was further adjusted according to individual tolerance. We did not include patients who were known narcotic addicts or who were in the course of compensation settlement. Patients interviewed for subjective degree of pain relief by someone not involved in administering the acupuncture were asked to grade the degree of relief as 0, 25, 50, 75, or 100%. Follow-up was in person, by mail, and by telephone.
TABLE 2 Duration of Pain Prior to Acupuncture Treatment ~~
~~
Number of Duration
6 to 12 months 2 to 5 years 7 to 8 years 10 to 15 years 20 t o 40 years Total
oatientr
9
30
5 12 10 66
RESULTS Of 533 patients, 276 (52%) reported excellent ( > 75%) pain relief immediately after the last treatment and 103 (19.3%) still reported excellent pain relief on the 4-week posttherapy questionnaire. In March 1975, we contacted 87 of these patients either by a 2nd questionnaire or by telephone. (We were unable to reach the remaining 16 patients.) Of these, 21 patients reported that their pain had returned to the same intensity as before therapy; 63 still had >75% degree of pain relief at 3 to 18 months after therapy; and 3 patients reported their pain still to be relieved 50%. Thus, 12% of the patients contacted had residual pain relief (table 1). As in our previous study, there was no
significant difference in the incidence of pain relief whether the needle placement was in traditional meridian locations or in arbitrary control points.
TABLE 1
DISCUSSION Neither the mechanism of chronic pain nor the mechanism of acupuncture is fully understood. Thus, treating chronic pain with acupuncture is analogous to a blind person riding a blind horse. Yet, there are numerous testimonials of acupuncture therapy relieving the pain of low back discomfort, arthritis, neuralgia, and headache.1-6Of the 533 patients treated in our study, all had been treated previously with drugs and many had been treated surgically. When pain persisted, patients sought acupuncture as an alternative to conventional modes of therapy. While 52% of patients reported at least 75% relief of pain immediately after their last acupuncture treatment? pain returned to many. However, 4 weeks later, 19.3% of patients still had excellent pain relief.
Duration of Relief of Pain Following Acupuncture Number of Duration
100% relief 3 to 5 months 6 months 7 to 9 months 11 t o 18 months Total 7 5 v ~relief 3 to 6 months 7 to 12 months 15 to 18 months Total 50% relief 3 months 11months Total
potientr
16 7 8
9
40 10 8 5
23
I
2
3
Of the 66 patients who reported pain relief at least 3 months after therapy, 9 had suffered from pain for less than 1year before therapy, 35 reportedly suffered from pain from 2 to 8 years, and 22 stated that they had been in pain for at least 10 years (table 2 ) . Thirteen patients had resumed pain medications but in smaller doses than previously used. The remaining 53 patients were no longer taking pain medication. The pretreatment diagnoses of these 66 patients are shown in table 3. Thirty-four patients were male and 32 were female, with a mean age of 61.3 rt 14 years.
Although the incidence of pain relief fell considerably between the last treatment and the 4-week follow-up, the majority of patients who still had significant pain relief
Acupuncture for Pain Relief
. . . Lee, et a1
23 1
TABLE 3 Diagnosis of 66 Patients Who Received Long-Lasting (3 to 18 Months) Relief Following Acupuncture Treatment* Number of Diagnosis
patients
Low back pain Post disc surgery; laminectomyjfusion Unknown etiology Degenerative disc disease Spondylolisthesis
Total Osteoarthritis, spine/extremities Neuralgia Postherpetic Postsurgery Postinjection Tic douloureux Peripheral neuropathy Total Headache Migraine Cervical arthritis Tension headache Cause unknown Total Traumatic arthritis Other
Since there was no difference between those patients who received their therapy along traditional meridians and those who received needles at arbitrarily selected points, we question whether the results of our study represent the results of “acupuncture’’ or the results of “counterstimulation.” Our study was not designed to offer an explanation of the mechanism by which our patients obtained pain relief. However, we did attempt to study the placebo effect by placing needles in other than the traditional meridians. This portion of our study suggests that electrical stimulation at traditional meridians was unimportant. However, if the effectiveness of therapy is due to counterstimulation, this, too, would be produced by the electrical stimulation of the needles in the arbitrary control points. Thus, it was impossible for us to separate a placebo effect from this mechanism.
ACKNOWLEDGMENT The authors thank Ms. Sherry Kamradt and Mr. Daniel Roberson for their assistance in retrieving the follow-up data.
REFERENCES 1. Lee PK, Andersen TW, Modell JH, et al: Treatment of chronic pain with acupuncture. JAMA 232:1133-1135, 1975 2. Rarke M W : A retrospective study of acupuncture. Am J Acupunc 2:88-93, 1974
*Number in brackets is total patients in each entity.
3. Kim DC, Yount RA: The effect of acupuncture on low back pain. Am J Chin Med 2:421-428, 1974
4 weeks after therapy experienced this re-
of headache. A preliminary report. Am J Acupunc
lief for at least 3 months. While immediate relief of pain after acupuncture therapy may be a poor indicator of long-term results, our experience suggests that the majority of the patients who have pain relief for at least a month can look forward to long-term effectiveness.
4. Lawrence RM: Acupuncture for the treatment
2:105-108, 1974 5. h u n g SJ: Acupuncture treatment of pain syndrome. Part I. Treatment of sciatica. Am J Chin Med 1:317-326, 1973 6. Weiss SL: Management of low back pain syndromes with acupuncture. Am J Acupunc 2:180184, 1974
229
Incidence of Prolonged Pain Relief Following Acupuncture PETER K.
Y.
LEE, M D *
JEROME H. MODELL, M D t THORKILD W. ANDERSEN, M D $ SEGUNDINA A. SAGA, MDS
Gainesville, Florida 11
From March 1973 t o December 1974, 2090 electroacupuncture treatments were applied to 533 patients with chronic pain. Of 533 patients, 276 (52%) reported excellent (>750/0) pain relief immediately a f t e r t h e l a s t treatment, and 103 (19.3%) still reported excellent pain relief on a &week follow-up questionnaire. I n March 1975, t h e authors contacted 87 of these 103 patients. Sixty-three reported t h a t they
still had excellent pain relief 3 t o 18 months a f t e r therapy, 3 patients reported t h a t their pain still was relieved 50%, and 21 patients said their pain had returned t o t h e same intensity as before therapy. Thus, 12% of 533 patients who received acupuncture treatment f o r chronic pain had a significant degree of pain relief a t least 3 months a f t e r therapy.
W
of this report is to identify those patients who received relief from pain for more than 3 months after acupuncture therapy.
reported on 261 patients who received up to 4 consecutive acupuncture treatments for chronic pain.' In that study, 133 patients were treated with electrically stimulated needles placed in traditional acupuncture meridians. The remaining 128 patients also received electrical-needle stimulation; however, these had been placed alternately in traditional meridians and in arbitrary locations. We found that 117 patients (54%) reported that their pain was either relieved completely or had decreased in intensity by at least 75% immediately after the 4th treatment. In a 4-week follow-up questionnaire, 47 (18.6%) of the 252 patients who responded still had at least 75% relief from pain.' Needle placement did not influence the results in that study. We have continued to study patients using this modality, to determine the incidence of long-term pain relief. The purpose E PREVIOUSLY
METHODS Between March 1973 and December 1974, 2090 acupuncture treatments were applied to 533 patients suffering from chronic pain. All patients received 3 treatments on successive days and most returned for a 4th treatment. Results of the 4-week follow-up were reported previously in 252 patients (9 patients did not answer the 4-week questionnaire) .1 The remaining 272 patients were treated similarly with needles being placed at traditional meridian points. These have not been reported. Electroacupuncture was performed via 27-gauge hypodermic needles by an electric stimulator with 0.35 ms pulse width; biphasic-capacitor-coupled square wave; pulse rate 10 to 300/sec; and
*Visiting Research Professor. ?Professor and Chairperson. $Professor. $Assistant Professor. IlDepartment of Anesthesiology, University of Florida College of Medicine, J. Hillis Miller Health Center, Gainesville, Florida 32610. Paper received: 7/10/75 Accepted for publication: 8/14/75
ANESTHESIA AND ANALGESIA . . . Current Researches VOL.55, NO. 2, MARCH-APRIL, 1976
230
amplitude 0 to 12 volts variable control. The adjustable controls were set to 200 pulses/sec and 3 volts. The amplitude was further adjusted according to individual tolerance. We did not include patients who were known narcotic addicts or who were in the course of compensation settlement. Patients interviewed for subjective degree of pain relief by someone not involved in administering the acupuncture were asked to grade the degree of relief as 0, 25, 50, 75, or 100%. Follow-up was in person, by mail, and by telephone.
TABLE 2 Duration of Pain Prior to Acupuncture Treatment ~~
~~
Number of Duration
6 to 12 months 2 to 5 years 7 to 8 years 10 to 15 years 20 t o 40 years Total
oatientr
9
30
5 12 10 66
RESULTS Of 533 patients, 276 (52%) reported excellent ( > 75%) pain relief immediately after the last treatment and 103 (19.3%) still reported excellent pain relief on the 4-week posttherapy questionnaire. In March 1975, we contacted 87 of these patients either by a 2nd questionnaire or by telephone. (We were unable to reach the remaining 16 patients.) Of these, 21 patients reported that their pain had returned to the same intensity as before therapy; 63 still had >75% degree of pain relief at 3 to 18 months after therapy; and 3 patients reported their pain still to be relieved 50%. Thus, 12% of the patients contacted had residual pain relief (table 1). As in our previous study, there was no
significant difference in the incidence of pain relief whether the needle placement was in traditional meridian locations or in arbitrary control points.
TABLE 1
DISCUSSION Neither the mechanism of chronic pain nor the mechanism of acupuncture is fully understood. Thus, treating chronic pain with acupuncture is analogous to a blind person riding a blind horse. Yet, there are numerous testimonials of acupuncture therapy relieving the pain of low back discomfort, arthritis, neuralgia, and headache.1-6Of the 533 patients treated in our study, all had been treated previously with drugs and many had been treated surgically. When pain persisted, patients sought acupuncture as an alternative to conventional modes of therapy. While 52% of patients reported at least 75% relief of pain immediately after their last acupuncture treatment? pain returned to many. However, 4 weeks later, 19.3% of patients still had excellent pain relief.
Duration of Relief of Pain Following Acupuncture Number of Duration
100% relief 3 to 5 months 6 months 7 to 9 months 11 t o 18 months Total 7 5 v ~relief 3 to 6 months 7 to 12 months 15 to 18 months Total 50% relief 3 months 11months Total
potientr
16 7 8
9
40 10 8 5
23
I
2
3
Of the 66 patients who reported pain relief at least 3 months after therapy, 9 had suffered from pain for less than 1year before therapy, 35 reportedly suffered from pain from 2 to 8 years, and 22 stated that they had been in pain for at least 10 years (table 2 ) . Thirteen patients had resumed pain medications but in smaller doses than previously used. The remaining 53 patients were no longer taking pain medication. The pretreatment diagnoses of these 66 patients are shown in table 3. Thirty-four patients were male and 32 were female, with a mean age of 61.3 rt 14 years.
Although the incidence of pain relief fell considerably between the last treatment and the 4-week follow-up, the majority of patients who still had significant pain relief
Acupuncture for Pain Relief
. . . Lee, et a1
23 1
TABLE 3 Diagnosis of 66 Patients Who Received Long-Lasting (3 to 18 Months) Relief Following Acupuncture Treatment* Number of Diagnosis
patients
Low back pain Post disc surgery; laminectomyjfusion Unknown etiology Degenerative disc disease Spondylolisthesis
Total Osteoarthritis, spine/extremities Neuralgia Postherpetic Postsurgery Postinjection Tic douloureux Peripheral neuropathy Total Headache Migraine Cervical arthritis Tension headache Cause unknown Total Traumatic arthritis Other
Since there was no difference between those patients who received their therapy along traditional meridians and those who received needles at arbitrarily selected points, we question whether the results of our study represent the results of “acupuncture’’ or the results of “counterstimulation.” Our study was not designed to offer an explanation of the mechanism by which our patients obtained pain relief. However, we did attempt to study the placebo effect by placing needles in other than the traditional meridians. This portion of our study suggests that electrical stimulation at traditional meridians was unimportant. However, if the effectiveness of therapy is due to counterstimulation, this, too, would be produced by the electrical stimulation of the needles in the arbitrary control points. Thus, it was impossible for us to separate a placebo effect from this mechanism.
ACKNOWLEDGMENT The authors thank Ms. Sherry Kamradt and Mr. Daniel Roberson for their assistance in retrieving the follow-up data.
REFERENCES 1. Lee PK, Andersen TW, Modell JH, et al: Treatment of chronic pain with acupuncture. JAMA 232:1133-1135, 1975 2. Rarke M W : A retrospective study of acupuncture. Am J Acupunc 2:88-93, 1974
*Number in brackets is total patients in each entity.
3. Kim DC, Yount RA: The effect of acupuncture on low back pain. Am J Chin Med 2:421-428, 1974
4 weeks after therapy experienced this re-
of headache. A preliminary report. Am J Acupunc
lief for at least 3 months. While immediate relief of pain after acupuncture therapy may be a poor indicator of long-term results, our experience suggests that the majority of the patients who have pain relief for at least a month can look forward to long-term effectiveness.
4. Lawrence RM: Acupuncture for the treatment
2:105-108, 1974 5. h u n g SJ: Acupuncture treatment of pain syndrome. Part I. Treatment of sciatica. Am J Chin Med 1:317-326, 1973 6. Weiss SL: Management of low back pain syndromes with acupuncture. Am J Acupunc 2:180184, 1974
