Chronically painful conditions of the musculoskeletal system accompanied by restricted movements of the joints are often treated with acupuncture. Acupuncture not only alleviates pain, but also reduces muscle spasm, thereby increasing mobility. Joint damage often results from muscle malfunction, and many patients complain of arthralgia (or joint pain) before any changes are demonstrable by X-ray. In these cases, acupuncture may bring about a permanent cure.
Arthritis is a form of joint disorder that involves inflammation of one or more joints.(1) There are more than 100 different forms of arthritis. The most common form, osteoarthritis (degenerative joint disease), is a result of trauma to the joint, infection of the joint, or age. Another common form, rheumatoid arthritis, occurs when body’s immune system attacks the tissues of the body. The major complaint by individuals who have arthritis is joint pain, due to inflammation around the joint, damage to the joint, wear and tear of the joint, muscle strains caused by forceful movements against stiff painful joints and fatigue.(2)
There is no known cure for either osteoarthritis or rheumatoid arthritis. Treatment is focused on relieving symptoms and improving joint function. Treatment options vary depending on the type of arthritis and include physical therapy, lifestyle changes (including exercise and weight control), orthopedic bracing, alternative therapies (such as acupuncture), and medications. Joint replacement surgery may be required in eroding forms of arthritis. Medications can help reduce inflammation in the joint which decreases pain, but have adverse effect.(3) In recent years, acupuncture has become increasingly more popular in arthritis management.(4,5)
Current evidence supports the use of acupuncture as an alternative for traditional analgesics in patients with arthritis.(6) The use of acupuncture is associated with significant reductions in pain intensity, improvement in functional mobility and quality of life. While acupuncture may not improve the damage that has been done to the joints, successful pain relief has been verified in the majority of controlled studies.(7) The action of acupuncture on inflammation and the dysfunctional immune system is also proved to be beneficial.(8) The conclusion is that acupuncture is an effective and judicious adjunct to conventional care for arthritis patients.
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Back & Neck Pain
Back and neck pain affect 65-80% of the general population at certain time of their lives. It is responsible for much disability and health care expenditure. People having chronic back and/or neck pain often do not respond to or develop side effects from conventional treatments such as injections and medications.(1) Consequently, there has been substantial interest in use of complementary and alternative medicine (CAM) therapies for management of back/neck pain. The most common CAM therapies include spinal manipulation, acupuncture and massage.(2)
In a randomized controlled trial,(3) 177 chronic neck pain patients were randomly allocated to an acupuncture, massage and control group respectively. Patients in the acupuncture group were treated at regular and ear acupuncture points, along with myofascial trigger points. In the massage group, patients were treated with various Western techniques, including friction, tapotement and vibration. In the control group, sham laser acupuncture was performed using an inactivated laser probe on the same acupoints as patients in the acupuncture group. A 'blinded' researcher evaluated the effectiveness of the treatments using a score of 100 points to measure the amount of pain, tolerance to pressure, and quality of life of each patient.
Patients in the acupuncture group improved an average of 24 points on pain associated with motion one week after treatment, compared to only 8 points for massage patients. These differences were even more distinct among patients with myofascial pain syndrome and among patients who reported pain lasting more than 5 years. Similar results were also found in other measurements. For instance, in the measurements taken seven days after the last treatment, over half of the patients treated with acupuncture reported an improvement of over 50% in pain associated with motion, compared to only 32% of patients treated with massage, and less than 25% of patients in the sham acupuncture group.
In another randomized controlled trial of 1162 patients with chronic low back pain,(4) the patients underwent ten 30-minute sessions of acupuncture (n = 387) according to principles of Traditional Chinese Medicine; sham acupuncture (n = 387) consisting of superficial needling at non-acupuncture points; or conventional therapy, a combination of drugs, physical therapy, and exercise (n = 388). At 6 months, the response rate was 47.6% in the acupuncture group, 44.2% in the sham acupuncture group, and 27.4% in the conventional therapy group. The investigators concluded that low back pain improved after acupuncture treatment for at least 6 Months. Effectiveness of acupuncture was almost twice that of conventional therapy.
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Frozen Shoulder & Tennis Elbow
Frozen shoulder and tennis elbow are two most common localized rheumatic conditions resulting in pain and disability. Frozen shoulder is a condition characterized by stiffness and pain in the shoulder joint.(1) It can be categorized as either primary when its cause is unknown, or secondary, when it can be attributed to another cause such as rotator cuff injury.(2) Tennis elbow is characterised by pain and tenderness over the lateral epicondyle of the humerus.(3) Tennis elbow typically occurs after minor trauma of the extensor muscles of the forearm. Tennis is a direct cause in only 5% of people with the condition.(4) Pain can also occur on the inner side of the elbow, which is known as golfer's elbow. Signs and symptoms of both conditions typically begin gradually, worsen over time and then resolve, usually within 1-2 years.
Conventional interventions for the two conditions include drug (e.g., corticosteroid injections, topical and oral NSAIDs, other analgesics) and non-drug (e.g., exercises, ultrasound, and surgery) therapies. Although local steroid injections are one of the most common treatments, there is no strong evidence to support their use, and they have potential adverse effects.(5) The need for a safe and effective treatment is therefore paramount. Acupuncture has widely been used to treat both conditions. A latest comprehensive systematic review on randomized controlled trials of acupuncture and moxibustion for tennis elbow concludes that acupuncture is more effective than sham acupuncture in treatment of tennis elbow, and that acupuncture in combination with moxibustion is a more effective treatment regime than manual acupuncture alone.(6) Another systematic review concluded that acupuncture is likely to have short-term benefit with respect to pain and function among the patients with frozen shoulder.(7)
Possible mechanisms of acupuncture in treatment of frozen shoulder and tennis elbow may be the followings. Distal acupoints may activate diffuse noxious inhibitory control resulting in immediate pain relief.(8,9) Opioid released from the brain following acupuncture may result in a general analgesic effect.(10) Electro-acupuncture can produce non-opioid dependent anti-inflammatory effects via activation of the cholinergic anti-inflammatory pathway.(11,12) At the site of needle insertion acupuncture can also bring upon the release of neuropeptides involved in pain modulation and local vasodilatation.(13,14) Manual acupuncture at the site of needling can produce anti-inflammatory effects via adenosine release.(15) Acupuncture may increase local blood flow of the target tissue and affect fibroblast migration through myofascial collagen manipulation, both of which are conducive to reverse tendinopathic change.(16)
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Fibromyalgia (FM) is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep disturbance, memory and mood disorders, and other functional impairment, without any known structural or inflammatory cause.(1) It is believed that fibromyalgia amplifies painful sensations by affecting the way the brain processes pain signals.(2) The risk factors for the condition include female gender, anxiety, trauma and viral infection. In general, treatments for fibromyalgia include both drug and non-drug therapies. The emphasis is on minimizing symptoms and improving general health. Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include: pain relievers, antidepressants and anti-seizure medications.(3)
Complimentary and alternative therapies have increasingly gained popularity in stress relief and pain reduction among fibromyalgia patients, and some, such as acupuncture, Qi Gong, Tai Chi, and Yoga, are gaining acceptance in mainstream medicine. A 2013 systematic review of randomized controlled trials concluded that acupuncture or combination of acupuncture and cupping therapy was significantly more effective than conventional medications (anti-depression drugs or analgesic antipyretic) on reducing pain and improving the other symptoms (such as depression or fatigue).(4) Other studies suggest that acupuncture may have the greatest benefit when applied together with medication or other therapeutic options.(5,6)
Acupuncture may help relieve pain in patients with fibromyalgia by: (i) altering the brain's chemistry, increasing endorphins and neuropeptide Y levels, and reducing serotonin levels; (ii) evoking short-term increases in mu-opioid receptors binding potential, in multiple pain and sensory processing regions of the brain; (iii) stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord; (iv) reducing inflammation, by promoting release of vascular and immunomodulatory factors; and (v) improving muscle stiffness and joint mobility by increasing local microcirculation.(7)
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Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) is a hand and arm condition that causes numbness, tingling and other symptoms. CTS is caused by a pinched nerve in the wrist. A number of factors can contribute to CTS, including the anatomy of the wrist, certain underlying health problems and possibly patterns of hand use. Compression of the nerve produces the numbness, tingling and, eventually, hand weakness. People with mild symptoms of CTS can ease their discomfort by taking more frequent breaks to rest their hands, avoiding activities that worsen symptoms and applying cold packs to reduce occasional swelling. If these techniques don't offer relief, additional treatments such as medications (e.g., steroid), complementary and alternative therapies (e.g., acupuncture) or surgery may be necessary.(1)
Acupuncture has long been used for management of CTS, and has been proved to be beneficial. A recent randomized controlled trial with long term follow-up (13 months) compared acupuncture with oral steroids in management of CTS. Patients with acupuncture treatment had significantly better improvement in Global Symptom Score, Distal Motor Latency and Distal Sensory Latency, compared to the steroid group. The results showed greater efficacy of acupuncture both in symptom assessment and objective changes in nerve conduction.(2) A Chinese study showed a promising effect of needle acupuncture compared with steroid block therapy in terms of responder rate.(3) A meta-analysis of acupuncture versus steroid nerve blocks further confirmed this result.(4)
Many studies have investigated the mechanism of acupuncture on CTS. Studies using functional magnetic resonance imaging (fMRI) showed that acupuncture stimulation caused a change in brain processing or a coordinated limbic response.(5,6) Other studies suggested that acupuncture has an anti-inflammatory and immune modulator effect.(7,8) Although the exact mechanism of acupuncture effects on CTS is not fully understood, a latest study demonstrated effectiveness of this method in management of CTS.(9) While a study investigated side effects of acupuncture in CTS, indicating some side effects such as swelling and pain in treatment hand,(10) others did not detect any side effect in acupuncture or control group.
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Temporomandibular Joint (TMJ) Disorders
The temporomandibular joint (TMJ) acts like a sliding hinge, connecting the jawbone to the skull. TMJ disorders can cause pain in the jaw joint and in the muscles that control jaw movement. Some people who have jaw pain also tend to clench or grind their teeth, but many people habitually clench their teeth and never develop TMJ disorders. The exact cause of TMJ disorder is often difficult to determine. In some cases, the symptoms of TMJ disorders may go away without treatment. In most cases, the pain and discomfort can be alleviated with medications (e.g., pain relievers and muscle relaxants) and/or complementary and alternative therapies such as acupuncture. Most severe TMJ disorders may require surgical repair.(1)
In conjunction with medications, acupuncture help relieve the pain associated with TMJ disorders. There is limited number of studies that investigate the mechanisms of acupuncture in treatment of TMJ disorders. One theory is that TMJ status is functionally connected to general body health status.(2,3) TMJ status exerts an influence on (i) synchronization of head and jaw muscles with the muscles from other body sites for proper body posture; (ii) body stability such as body equilibrium (balance), center of gravity fluctuation, and gaze stability; and (iii) physical performance along with physical fitness. Although further studies on the proposed mechanisms are needed, a systematic review of randomized controlled trials noted moderate evidence that acupuncture is an effective intervention to reduce symptoms associated with TMJ disorders.(4)
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