Introducing Acupuncture: For Arthritis and Chronic Pain
We're excited to announce that Acupuncture Awareness Week , a UK initiative led by the British Acupuncture Council, starts on 7th March 2016! In this blogpost we'll provide an overview on how acupuncture can be helpful for arthritis, one of the most common chronic pain conditions we see at our Hertfordshire clinic.
Arthritis is a leading cause of pain and disability in the UK with osteoarthritis and rheumatoid arthritis being two of the most commonly diagnosed conditions in general practice (NICE 2014). In the UK, a third of people aged 45 years and over have previously sought treatment for osteoarthritis which frequently affects the knee, hip and hand joints (ARUK 2013). Common arthritic symptoms include joint pain, stiffness and limited range of movement but many are also affected by other symptoms associated with arthritis such as tiredness and sleeplessness.
How is arthritis normally managed?
Arthritic symptoms can be well-managed using a combination of different approaches available from your GP and which are effective in the majority of cases. This will often include prescription of medications such as paracetamol, anti-inflammatories and steroids, as well as recommendations to maintain movement of the joint as much as possible through muscle-strengthening exercises, stretching or improving fitness levels. Practitioner-led treatments such as physiotherapy or manipulative treatments such as osteopathy or chiropractic can also be beneficial. As weight directly contributes to the burden on load-bearing joints such as the knees and hips, it is common for doctors to discuss strategies to manage weight, or to maintain a healthy weight.
What if these treatments don't work for me?
Although arthritis can be well-managed with a combination of different treatments, it is now well-recognised by charities such as Arthritis Research UK that some patients do not find these treatments effective for their pain, or they may not be suitable for some approaches due to risks or side-effects. For example aspirin is likely not to be prescribed for patients at particular risk of stomach bleeding, and surgery may not be appropriate for every patient. Where these treatments appear to be of limited use, pain specialists are increasingly recommending other approaches such as acupuncture.
What does the research on acupuncture and pain say?
Acupuncture is one of the most widely researched complementary therapies and a recent systematic review showed that acupuncture is effective for chronic pain - more so than no acupuncture and sham acupuncture (Vickers et al 2012). Of particular interest is a recent evaluation of an acupuncture service offered at 2 GP practices in St Albans in Hertfordshire for symptoms of osteoarthritis of the knee (White 2012). Practice nurses offered acupuncture to patients who were willing to consider it as an alternative to knee surgery. After 4 weeks, significant improvements were seen in terms of pain, stiffness and function, improvements that continued to be seen at follow-up 2 years later (White 2012). This led the study authors to conclude that acupuncture is safe, acceptable and cost-effective and that it should be offered by clinical commissioners as part of conservative management for knee osteoarthritis prior to total knee replacement (White 2012).
Treatments for pain aim to bring about lasting relief by breaking the cycle of pain. This can occur when an incident such as an injury or repetitive strain results in soft tissue pain, which can cause muscles to spasm in a protective manner. This may alter the functioning of nerves and of the joint locally but which may also lead to joint stiffness and muscular weakness from reduced use and muscular 'guarding'. This process is helpful in acute situations to help alert us to injury and to enable us to protect it from further damage. However, when this occurs on a long term basis, it can cause the affected area to decondition and which can lead to further pain and further spasm as the muscles and the joint becomes used less and less. Pain management techniques such as acupuncture can be helpful in interrupting this cycle of events.
Research into acupuncture for pain has involved looking at a number of processes and it is possible that relief comes about in a number of ways. For example, research studies have shown that acupuncture can stimulate the body to produce and release more of its own pain-relieving chemicals known as endorphins and encephalins, low levels of which have been previously associated with chronic pain (Han 1982, Han 1986, Almay 1978). Acupuncture is also known to influence the central nervous system, affecting the pain signals being sent to the brain. Harvard researchers have furthermore demonstrated that acupuncture regulates activity in areas of the brain involved with processing pain as a way of influencing the experience of pain (Hui 2000). Given that many patients report a feeling of wellbeing after acupuncture and see improvements in mood, anxiety, stress levels and in sleep, it is possible that acupuncture can reduce the negative effects of stress and anxiety and improve pain levels in this way.
Can I get treatments on the NHS?
Acupuncture is accessible on the NHS to some patients with arthritis depending on how the local Clinical Commissioning Group (CCG) in your area has determined funding. In Hertfordshire, acupuncture can be accessed through physiotherapists working in Pain Clinics in and around the local area. Access on the NHS can be limited to the specific condition you have so please ask your GP or consultant for further information and where it is available they will be able to arrange a referral for you. You will then be provided a set number of treatments, usually 6 or 10 weekly sessions. Remember to ask your physiotherapist at the beginning of the treatment how soon you should expect to see an improvement.
Based on our experiences at the Whittington Hospital Pain Clinic in North London, our advice to patients is that some improvements in symptoms can be experienced after the first session and that significant improvements should certainly be seen within 5 sessions of weekly treatments. If you would like to read experiences of others with arthritis, please find accounts of our previous patients undergoing treatments with us here. More general accounts of patients living with arthritis can also be found on the excellent website HealthTalk, an initiative by GPs and researchers based at the University of Oxford.
Do I need a referral from my GP to book with you?
A referral is not needed from your GP and you may self-refer at any time. However, we recommend that you speak to your GP before booking in to discuss availability of acupuncture on the NHS for your symptoms, as well as to ensure that other options have been exhausted before booking in for treatment with us.
Other sources of information and support
Almay BG, Johansson F, Von Knorring L, Terenius L, Wahlstrom A. Endorphins in chronic pain. I. Differences in CSF endorphin levels between organic and psychogenic pain syndromes. Pain. 1978;5(2):153-62.
ARUK. Osteoarthritis in General Practice: Data and Perspectives. 2013.
De Silva V, El-Metwally A, Ernst E, Lewith G, Macfarlane GJ, Arthritis Research UKWGoC, et al. Evidence for the efficacy of complementary and alternative medicines in the management of osteoarthritis: a systematic review. Rheumatology. 2011;50(5):911-20.
Han JS, Terenius L. Neurochemical basis of acupuncture analgesia. Annual review of pharmacology and toxicology. 1982;22:193-220.
Han JS, Ding XZ, Fan SG. Cholecystokinin octapeptide (CCK-8): antagonism to electroacupuncture analgesia and a possible role in electroacupuncture tolerance. Pain. 1986;27(1):101-15.
Hui KK, Liu J, Makris N, Gollub RL, Chen AJ, Moore CI, et al. Acupuncture modulates the limbic system and subcortical gray structures of the human brain: evidence from fMRI studies in normal subjects. Human brain mapping. 2000;9(1):13-25.
Nho SJ, Kymes SM, Callaghan JJ, Felson DT. The burden of hip osteoarthritis in the United States: epidemiologic and economic considerations. The Journal of the American Academy of Orthopaedic Surgeons. 2013;21 Suppl 1:S1-6.
NICE 2014. Osteoarthritis: Care and management in adults. In: CENTRE, N. C. G. (ed.).
Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012;172(19):1444-53.
White A, Richardson M, Richmond P, Freedman J, Bevis M. Group acupuncture for knee pain: evaluation of a cost-saving initiative in the health service. Acupunct Med. 2012;30(3):170-5.