Pain can be life altering, as any patient can tell you. It changes personalities, erodes relationships, prevents physical activity, and blocks a person’s enjoyment of life. It is a huge social drain, with countless hours of work sacrificed. Pain management, in all its manifestations, is a multi-billion dollar industry.
It’s no wonder that one of the most common reasons people seek acupuncture treatment is for pain resolution. In fact, acupuncture is often a very successful modality for pain relief. Even mainstream doctors are starting to recommend it when their patients’ prognosis goes beyond the limits of conventional medical care. Western medicine basically has only a few options to treat pain namely surgery, medication and physical therapy. These options can be very powerful and healing and I would highly recommend them when appropriate. My general philosophy about medical intervention, however, is that it is wisest to start with the least invasive methods first, leaving the most invasive measures as a last resort. Too often, this process is reversed. In my fantasy world of truly integrative health care, acupuncture would be considered a viable treatment, either primary or complementary, very early in the process. Determining at what point and to what extent acupuncture should be part of a treatment strategy depends on the nature of the source of the pain, as I will detail later.
Beginning a discussion of how and why acupuncture provides relief beyond the Western approach requires a brief exploration of pain from a Chinese medicine point of view. In Chinese medicine we relate the functioning of the body to the role of Qi. Qi is very difficult to translate, but it is generally described as vital energy that flows throughout the body, much like the blood circulatory system. Freedom from pain requires the unimpeded flow of Qi in a continuous circuit. Think of a moving water system like a stream. If nothing obstructs the way, the water flows freely. If there are rocks, trees, or a beaver dam, the water, to varying degrees, stops flowing. There is less water flowing downstream, an accumulation of water upstream, and higher water pressure at the point of obstruction. If we substitute the concept of Qi for water, we can get less Qi flowing downstream (perhaps numbness or coldness), excess Qi stagnation upstream (perhaps edema or distention), and pain at the point of obstruction.
Acupuncture treatment strategies to treat pain are relatively straightforward. If Qi is obstructed, the goal is to relieve the obstruction and return the free flow of Qi to its natural continuous circuit. From a diagnostic standpoint, the nature of the pain will reveal the nature of the Qi obstruction and guide treatment strategies. Dull pains tell us one thing, sharp stabbing pains another, traveling pains again something else. Other clues will be the location and duration of the pain, the influences of the application of heat or cold, etc.
Successful treatment of pain with acupuncture lies not only in identifying the nature of the obstruction, but also in correctly analyzing the details of its underlying causes. This is where we begin to discern what interaction, if any, acupuncture should have with conventional medical treatment. For this discussion, it is helpful to categorize pain into two general classes: pain with a known physiological cause and pain without a known physiological cause.
The first category usually comes with a significant Western diagnosis, perhaps through X-rays, MRIs, CT scans, ultrasounds, or other medical technology. What is usually at stake here is physical injury or trauma or the detection of some abnormality in form (arthritis, tumors, nodules, bone spurs, degenerated discs). This diagnostic information is of great help in determining the likely prognosis and choosing the appropriate treatment strategies. Generally speaking, the more intractable the physiological problem, the more temporary the acupuncture relief will be. This is because acupuncture will not reverse an underlying permanent cause. This is often the case with degenerative arthritis or bony growths such as bone spurs. With sustained treatment, acupuncture can often achieve impressive pain relief in these cases. However, patients need to understand that it becomes a pain management tool, one that will likely be needed indefinitely. Patients may find this acceptable, particularly when traditional Western approaches are inappropriate or undesirable. Sometimes patients are unable to undergo surgery, have reached the limit of pain medication, or have taken physical therapy as much as possible. Obviously, there are also times when surgery and/or physical therapy are the best possible treatments. In these cases, acupuncture can play an important complementary role in speeding healing time, reducing the need for medications, and reducing postoperative pain.
Another purely physiological cause of pain that is often overlooked by doctors is pain as a side effect of certain prescription medications. In particular, statins, such as Lipitor and Crestor, are known to cause nerve and muscle pain. The Chinese medical remedy for drug-induced pain is to stop taking the drug. Alternative approaches can be explored.
Now to a more interesting topic: those painful conditions that have no known physiological cause. These cases often come with no diagnosis or a Western diagnosis that is meaningless. Fibromyalgia is a prime example of a meaningless diagnosis. It’s not that I think fibromyalgia isn’t real. I have successfully treated many patients with this label and they all had very real pain. The diagnosis is meaningless from a Western medical perspective because no physical cause is attributed to it, and therefore no effective curative treatment model exists. Medications used for fibromyalgia are for temporary symptomatic relief only.
We have now touched on the realm where Chinese medicine is hugely advantageous and, frankly, should be used as primary care. There is real pain, but no cause that manifests physically. No tumors, no lesions, no arthritis. This covers a wide spectrum of chronic pain patients. We can include in this list the majority of migraines and headaches; period bread; non-arthritic joint pain; fibromyalgia, premenstrual breast pain; persistent pain from statins, even after they are no longer in the bloodstream; post-surgical or injury pain where physical examination reveals that the tissue is completely healed; and really any pain where the doctor shrugs off a prescription for painkillers and Xanax. This is where we look for the energetic causes of Qi blockages which in turn cause the pain. Common causes that we recognize in Chinese medicine would include persistent Qi obstruction from old injuries or surgeries (even decades old); previous exposure to extreme cold (including in an operating room); exposure to toxic heat (such as radiation); stored emotional or physical trauma, particularly in the case of sexual abuse; Systemic imbalances that cause Qi to forcefully rise to the head without completing its downward circuit (causing headache). In short, we identify and treat any underlying Qi imbalance that would tend to create a disruption in the proper flow of Qi.
From a Chinese medicine point of view, the sources of pain can be seen and treated as both physical and non-physical. Because it is a more holistic paradigm, acupuncture can often successfully treat pain beyond the limits of Western medicine. It is a relatively non-invasive treatment that offers immeasurable relief from unnecessary suffering at low cost and low risk. Anyone who suffers from pain, whether chronic or acute, should consider it a viable treatment option.